3. INTRODUCTION
• Muscular strength (MusS) has been
increasingly utilized to stratify cardiovascular
(CV) and metabolic risks in healthy
individuals and in those with acute and chronic
conditions and aging-associated
cardiometabolic abnormalities
• The assessment of MusS is more convenient
and relatively inexpensive
4. • Assessment is required for the evaluation and
identification of nutritional status and body
composition abnormalities such as frailty,
sarcopenia, and sarcopenic obesity, known
contributors to reduced quality of life and
increased hospitalization morbidity and
mortality and several cardiometabolic diseases.
5. • MusS has also been associated with
cardiometabolic risk factors
• MusS as a potential therapeutic target using
non pharmacologic strategies such as exercise
training, increased physical activity, and
dietary changes.
6. ASSESSMENT OF MUSCULAR STRENGTH
USING HANDGRIP STRENGTH
• MusS can be conveniently, reliably, and safely
estimated by measuring handgrip strength
(HGS) using a dynamometer
• HGS can be used alone, or in combination
with other tests.
• HGS does not provide a measure of whole
body MusS, it is well correlated with measures
of MusS obtained from the arm, leg, and trunk.
7. • The HGS procedure requires a maximal isometric
contraction of the forearm, performed in either the
standing or sitting positions, without the elbows
being supported
• critically ill, that are unable to maintain their
elbows unsupported during HGS, elbows may be
supported in a bed or armchair to still obtain
reasonable accuracy in the assessment of MusS.
• Individuals are instructed to squeeze the
dynamometer for 3-5 sec and the maximal value
of three measurements is recorded.
8. MUSCULAR STRENGTH AND CVD
• An analysis of 588 men suggested that dynapenia
in youth can predict the risk of CVD and CVD-
related events in adults
• Greater MusS in youth measured using a
standardized score of three isometric MusS tests
(HGS, elbow flexion, and knee extension), had a
12% relative risk (RR) reduction for CVD as
adults but without a significant association with
CVD-related mortality.
9. • Although dynapenia was not associated with
incident CVD it is associated with a 31% RR
increase for CVD mortality.
• In a large analysis of 1160082 healthy young
adults (mean 18 yr) on the risk of CVD,
particularly coronary heart disease (CHD) and
cerebrovascular diseases, after a 25-yr follow-up
(mean 44 yr),15 MusS assessed with HGS was
associated with significantly lower risk for CHD
and intracerebral infarction.
10. • Recent analysis of the Aerobics Center
Longitudinal Study (ACLS) in 8116 men, the
of MusS was associated with a substantial
reduction also for the risk of sudden cardiac
death even after adjustments for major
comorbidities and aerobic physical activity
level
• Reduced MusS has been recently associated
with greater risk for heart failure (HF
11. • MusS remains a very strong prognostic
determinant of health, preserving muscular fitness
over the course of the lifespan and also desirable
• A recent retrospective analysis of 1104 active
adult men aged 21-66 yr using an assessment that
combines both MusS and muscular fitness, such
as push-up capacity, found that greater push-up
capacity was associated with a marked lower risk
for CVD. Specifically, those individuals able to
complete >40 push-ups presented an impressive
96% RR reduction for CVD compared with those
who were unable to complete >10 push-ups.
12. • In patients with pre-diabetes and diabetes, every
1-kg increase of HGS was associated with a
progressive reduction in CVD events, in both men
and women, even after adjustments for
anthropometrics and age
• MusS has been associated with several CVD risk
factors and chronic diseases associated with
increased CVD risk, including metabolic
syndrome (MetS), type 2 diabetes mellitus
(T2DM), hypertension (HTN), and obesity.
13. • T2DM, an analysis of the Health, Aging, and
Body Composition study found that both men and
women with T2DM had significantly reduced
MusS compared with non-T2DM individuals
• Greater duration of T2DM (≥6 yr) and poor
glycemic control (glycated hemoglobin ≥8%)
were associated with a further reduction of MusS.
14. • Dynapenia has also been associated with
increased risk for HTN
• Obesity is a major risk factor for CVD
15. MUSCULAR STRENGTH TO IDENTIFY
NUTRITIONAL STATUS ABNORMALITIES
ASSOCIATED WITH INCREASED CV RISK
• HGS has been utilized to identify nutritional
status abnormalities, such as frailty and
sarcopenia.
• Both conditions are associated with increased
risk for CVD and all-cause mortality in
apparently healthy individuals as well as in
those with acute and chronic diseases.
16. FRAILTY
• Frailty reflects a state of decreased physiologic
reserve and increased vulnerability to stressors
• Frailty is associated with poor prognosis in a
number of acute and chronic conditions, highly
prevalent in older adults, but also increasing in
younger populations
• frailty is associated with increased risk to
develop CVD and markedly reduced survival
17. SARCOPENIA
• Sarcopenia has been growingly associated with
increased CV risk and all-cause mortality in
apparently healthy individuals as well as in
those with established diseases
• In a study of 4425 older adults, mean 70 yr, in
addition to finding a high prevalence of
sarcopenia of 37%, the presence of sarcopenia
corresponded with worse prognosis
18. • Presence of sarcopenia was associated with an
increased risk for CVD-related mortality in
women, but not in men, while in both women and
men sarcopenia was associated with an increased
risk for all-cause mortality by a 32% RR increase
• individuals with sarcopenia were significantly
more likely to present a high CV risk score (ie,
>10%) using the American College of
Cardiology/American Heart Association
guidelines
19. • Sarcopenia remains a major contributor to
reduced quality of life and exercise intolerance
in apparently healthy individuals as well as in
those with established CVD
20. References
• Artero EG, Lee DC, Lavie CJ, et al. Effects of muscular
strength on cardiovascular risk factors and prognosis. J
Cardiopulm Rehabil Prev. 2012;32(6):351-358.
• Carbone S, Billingsley HE, Rodriguez-Miguelez P, et
al. Lean mass abnormalities in heart failure: the role of
sarcopenia, sarcopenic obesity, and cachexia [published
online ahead of print March 28, 2019]. Curr Probl
Cardiol. doi:10.1016/j.cpcardiol.2019.03.006.
• Cruz-Jentoft AJ, Bahat G, Bauer J, et al. Sarcopenia:
revised European consensus on definition and
diagnosis. Age Ageing. 2019;48(1):16-31
21. • Franco CMC, Carneiro MAS, de Sousa JFR, Gomes
GK, Orsatti FL. Influence of high- and low-frequency
resistance training on lean body mass and muscle
strength gains in untrained men [pub- lished online
ahead of print April 18, 2019]. J Strength Cond Res.
doi:10.1519
• Frontera WR, Meredith CN, O’Reilly KP, Knuttgen
HG, Evans WJ. Strength conditioning in older men:
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