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Updated: Mar 10, 2026
Manual Muscle Testing: A Method of Measuring Extremity Muscle Strength Applied to Critically Ill Patients
Published on: April 12, 2011
Association of Muscle-specific Strength With Impaired Physical Function and Prognosis in Heart Failure: A Comparison
Koji Matsuo1, Kentaro Kamiya2, Daichi Maeda3
1Department of Rehabilitation Sciences, Kitasato University Graduate School of Medical Sciences, Sagamihara, Japan; Department of Rehabilitation, Sagamihara Kyodo Hospital, Sagamihara, Japan.
Objectives:
The Global Leadership Initiative on Sarcopenia has proposed muscle-specific strength, defined as muscle strength relative to muscle mass. Evidence in patients with heart failure (HF) is scarce; therefore, we compared the associations of muscle-specific strength with physical function and mortality in older patients with HF, in comparison with handgrip strength (HGS) alone.
Design:
A prospective multicenter study.
Setting And Participants:
This secondary analysis of the FRAGILE-HF cohort included patients aged ≥65 years hospitalized for HF.
Methods:
Four muscle-specific strength indices were defined as HGS divided by skeletal muscle mass index, upper limb skeletal muscle mass, mid-upper arm circumference, and forearm circumference. HGS and each muscle-specific strength index were categorized into sex-specific tertiles. Outcomes were impaired physical function at discharge (usual gait speed <1.0 m/s or 5-times sit-to-stand test ≥12 s) and all-cause mortality within 2 years.
Results:
Of 1332 enrolled patients, 873 were analyzed [median (interquartile range) age, 80 years (74-86 years), 57.5% men]. Lower HGS and lower values of all muscle-specific strength indices were associated with impaired physical function. Only HGS showed an independent association with 2-year all-cause mortality, with the high-HGS group having a lower risk than the low-HGS group (hazard ratio, 0.50; 95% CI, 0.32-0.79; P = .003), whereas muscle-specific strength indices were not consistently related to mortality. Across sexes, HGS generally demonstrated equal or higher areas under the curve than all muscle-specific strength indices for both impaired physical function and mortality.
Conclusions And Implications:
In older patients with HF, HGS provides practical prognostic information, and normalization of HGS by muscle mass did not improve prediction of physical function or mortality. These findings support the use of HGS as a simple tool for risk stratification, whereas the incremental value of muscle-specific strength indices appears limited.
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