Associations of Muscle Mass, Strength, and Power with Falls Among Active Community-Dwelling Older Adults

Background/Objectives: Falls are a leading cause of morbidity and mortality in older adults, even among those who are physically active. This study examined the associations between skeletal muscle mass, muscle strength, and muscle power and fall risk in physically active, community-dwelling older adults. Methods: A cross-sectional analysis was conducted with 280 participants (71.9 ± 5.3 years; 75% women) enrolled in the Stay Up-Falls Prevention Project. Assessments included skeletal muscle mass (anthropometric prediction equation), handgrip strength, lower limb strength and power (Five Times Sit-to-Stand test, 5×STS), and fall history over the past 12 months. Muscle power was calculated from 5×STS performance using the equation proposed by Alcazar and colleagues. Logistic regression models and receiver operating characteristic (ROC) curve analyses were performed. Results: Overall, 26.4% of participants reported at least one fall in the previous year, with a higher prevalence among women (28.9%) than men (18.8%). Fallers showed significantly lower handgrip strength (23.1 vs. 25.4 kg, p = 0.022) and poorer lower limb strength (9.2 vs. 8.7 s, p = 0.007) compared with non-fallers. However, no significant differences were found for skeletal muscle mass or sit-to-stand-derived power. In multivariable models adjusted for age, sex, body mass index, comorbidities, and medications, lower limb strength remained the only independent variable associated with fall status (OR = 1.78, 95% CI: 1.11-2.85, p = 0.016). ROC analysis confirmed fair discriminative capacity for 5×STS performance (AUC = 0.616, p = 0.003), with an optimal cut-off of 8.62 s (sensitivity = 78.4%, specificity = 33.0%). Handgrip strength, muscle mass, and power did not show independent associations with fall status. Conclusions: These findings indicate that the 5×STS test provides a simple, cost-effective, and functional indicator for fall-risk stratification in physically active older adults. Clinicians should consider the 5×STS as a sensitive functional indicator that contributes to fall risk stratification, ideally combined with complementary assessments (e.g., balance, gait, cognition) to improve risk stratification and guide preventive interventions in ageing populations.