Results
Basic characteristics of the study population are shown in Table 1. Both among subjects with and without COPD, and in both sexes, those with HD had significantly lower HGS (Figure 1).
Conclusions
In this population-based study, both women and men with heart
disease had lower hand grip strength regardless if they had COPD or
not. HGS was associated with disease severity assessed as FEV
1%
of predicted, however, the negative impact of heart disease lost
statistical significance when also adjusting for age and height.
1Respiratory symptoms: self-reported history of at least one of; modified Medical Research Council dyspnea scale >2,
chronic cough, chronic productive cough or recurrent wheeze. 2Heart disease: self-reported history of at least one of; angina
pectoris, myocardial infarction, cardiac insufficiency, coronary artery bypass or Percutaneous Coronary Intervention procedure. p-values<0.05 in bold, border line significant values in italics
Figure 2. Hand grip strength (kg) among subjects with (black) and without heart disease plotted by age among: a) women without COPD, b) women with COPD, c) men without COPD and d) men with COPD
Acknowledgements/funding
The authors thank Professor Bo Lundbäck, the initiator and scientific advisor of the OLIN studies, and Professor Eva Rönmark, the present head of the OLIN studies for their support. Ann-Christine Jonsson and Sigrid Sundberg are acknowledged for data collection. The authors also thank Ola Bernhoff for work with creating the data base of the study. The Swedish Heart-Lung Foundation, the Swedish Research Council, the Norrbotten County Council and Visare Norr are acknowledged for financial support.
Impact of heart disease on hand grip strength in COPD: epidemiological data
Viktor Johansson Strandkvist, PT, MSc
1,2, Helena Backman, PhD
2, Jenny Röding
1, PT, PhD, Caroline Stridsman
3, RN, PhD, Anne Lindberg
4, MD, PhD
1. Luleå University of Technology, Sweden, Department of Health Sciences, Division of Health and Rehabilitation 2. Umeå University, Sweden, Department of Public Health and Clinical Medicine, Division of Occupational and Environmental Medicine, the OLIN unit 3. Luleå University of Technology, Sweden, Department of Health Sciences, Division of Nursing 4. Umeå University, Sweden, Department of Public health and Clinical medicine, Division of Medicine
Background
Hand grip strength (HGS) and heart disease (HD) are related to mortality.1 Peripheral muscle dysfunction and HD are both frequently observed among subjects with Chronic Obstructive Pulmonary Disease (COPD), but the relationship between HGS and HD in COPD is unclear.
Aims
Our main aim is to evaluate the impact of heart disease (HD) on hand grip strength (HGS) among subjects with and without COPD, and further to evaluate HGS in relation to reference values.
Methods
Data was collected from the OLIN (Obstructive Lung Disease in Northern Sweden) COPD study, where subjects with COPD have been invited to annual examinations since 2005 together with age- and sex-matched subjects without COPD. During 2009, 441 subjects with COPD and 570 without COPD participated in examinations including structured interviews, spirometry and measurements of HGS. HGS was measured by a hand held dynamometer,
Jamar®,2 Bohannon reference values were used.3,4 COPD was defined as
post-bronchodilator FEV1/VC <0.70, the OLIN reference values for FEV1
where used when assessing COPD severity.5 All analyses was either stratified
by sex or adjusted for sex.
Women Men Non-COPD n=255 COPD n=195 p-value Non-COPD n=315 COPD n=246 p-value Age, mean (SD) 67.8 (10.3) 69.5 (9.7) 0.074 67.8 (10.2) 68.3 (9.0) 0.616 Smoker, n (%) 26 (10.2) 40 (20.6) 22 (7.0) 62 (25.2) Ex smoker, n (%) 93 (36.5) 82 (42.1) 154 (48.9) 135 (54.9) Non smoker, n (%) 136 (53.3) 73 (20.9) 0.001 139 (44.1) 49 (20.0) <0.001 Height, cm, mean (SD) 160.2 (6.7) 160.5 (6.2) 0.602 173.7 (7.5) 174.6 (6.6) 0.127 BMI, kg/m2, mean (SD) 27.9 (4.7) 26.7 (4.5) 0.007 27.6 (3.7) 27.1 (3.9) 0.141
FEV1 % of predicted, mean (SD) 97.2 (14.3) 80.1 (16.6) <0.001 93.7 (13.3) 74.6 (15.7) <0.001
Any respiratory symptoms1, n (%) 125 (49.0) 131 (67.2) <0.001 162 (51.4) 183 (74.4) <0.001
Heart disease2, n (%) 32 (12.5) 31 (15.9) 0.343 65 (20.6) 46 (18.7) 0.490
Hand grip strength, kg (SD) 26.9 (6.7) 25.8 (5.9) 0.053 46.3 (10.5) 45.9 (9.9) 0.676
0 10 20 30 40 50
No heart disease Heart disease
HGS among Women
Non-COPD COPD
No heart disease Heart disease
HGS among Men
Non-COPD COPD
In a multiple linear regression model HGS was significantly associated with FEV1% of predicted but not with heart disease among subjects with COPD when adjusted for age, sex and height (Table 2). In similar analyses stratified by sex, HGS was associated with FEV1% of predicted among men, but not among women with COPD. Analyses performed in the non-COPD group
yielded no significant findings regarding FEV1% of predicted or heart disease.
Women Men Total study population
B1 95% CI3 p-value B1 95% CI3 p-value B1 95% CI3 p-value
Non-COPD FEV1 %2 0,02 (-0.03 - 0.07) 0.468 0.03 (-0.03 - 0.10) 0.299 0.03 (-0.01 - 0.08) 0.115 Heart disease -0.36 (-2.48 - 1.76) 0.738 -0.44 (-2.65 - 1.78) 0.697 -0.78 (-2.37 - 0.82) 0.340 COPD FEV1 %2 0.02 (-0.02 - 0.07) 0.290 0.07 (0.01 - 0.14) 0.047 0.05 (0.01 - 0.09) 0.020 Heart disease -1.36 (-3.35 - 0.63) 0.179 -0.67 (-3.40 - 2.06) 0.629 -1.20 (-3.00 - 0.60) 0.180
Figure 1. Hand grip strength (mean kilogram) in COPD and non-COPD with or without heart disease, by sex.
1B=Beta coefficient from multiple linear regression models with HGS as dependent variable, adjusted for age, height, heart
disease, FEV1% and in the total study population also adjusted for sex. 2FEV
1%= Forced expiratory volume in 1 second,
percent of predicted. 395% CI= 95 % confidence interval. p-values<0.05 in bold, border line significant values in italics
p=0.002
p=0.005
p<0.001
p=0.003
References
1 Leong et al. Lancet. 2015, 386, 266
2 Mathiowetz et al. Journal of Hand Surgery 1984, 2, 222 3 Bohannon et al 2006 Physiotherapy. 2006, 92, 1.
4 Bohannon et al 2007, J Geriatr Phys Ther. 2007;30, 1. 5 Backman et al. Eur Clin Respir J. 2015, 2, 10
Viktor Johansson Strandkvist, PT.
Luleå University of Technology, Sweden, Department of Health Sciences, Division of Health and Rehabilitation 971 87 Luleå
The OLIN Studies Norrbotten County Council
E-mail: viktor.johansson.strandkvist@ltu.se
The proportion of subjects below estimated normal value for HGS was similar in subjects with and without COPD and in both sexes; among women (35.4 vs. 33.4%, p=0.714) and men (19.1 vs 15.9%, p=0.315) (Figure 2). There were no differences when analyses were stratified for presence of heart disease either.
Table 1. Study population, basic characteristics, comparing non-COPD and COPD among women and men, respectively
Table 2. Multiple linear regression models analyzing the association between HGS and FEV1% predicted and heart disease among subjects with and without COPD, respectively, adjusting for age and height
Data in this presentation is accepted for publication in The
International Journal of COPD. Johansson Strandkvist V,
Backman H, Röding J, Stridsman C & Lindberg A. Hand grip strength is associated with Forced Expiratory Volume in 1 second among subjects with COPD: report from a population-based
