1. Measuring physical capability Background

2. These slides can be used freely, translated and adapted to national use (e.g. concerning the equipment and fieldwork organization). However, it is important to keep in mind that no changes should be made to the measurement techniques, which need to be standardized.

3. Physical capability
Physical capability refers to an individual’s capacity to undertake physical tasks of everyday living (such as rising from a chair, walking at normal speed, carrying heavy loads)
Handgrip strength and chair stand tests are objective measures of physical capability
(Kuh et al. 2014; Cooper et al. 2010)

4. Correlates of poor physical capability
Musculoskeletal disorders (for example arthritis, rheumatic disorders) (Kuh et al. 2005)
Chronic diseases (for example CVD) (Bohannon 2015; Kuh et al. 2014; Leong et al. 2015)
Sedentary lifestyle, particularly lack of physical activity (Kuh et al. 2005; Leong et al. 2015)
Poor nutritional status (Bohannon 2015)
Genetics
14 – 60 % of differences in handgrip strength can be explained by genetics (Silventoinen et al. 2008; Tiainen et al. 2004)

5. Poor physical capability as a risk factor
Poor physical capability, especially at older age relate with higher risk of
Mortality (Cooper et al. 2010)
Cardiovascular disease (Cooper et al. 2011)
Accidents (falls) and fractures (Cooper et al. 2011)
Cognitive decline (Cooper et al. 2011)
Restrictions in daily activities (Kuh et al. 2014)

6. Muscle strength and physical capability
Measured handgrip strength and chair stand test performance reflect level of muscle strength (Bohannon et al. 2010; Bohannon 2015)
Muscle strength is required for activities of daily living such as stair rising or walking or carrying shopping bags (Macaluso & De Vito 2004; Rantanen et al. 1999)
Ageing is related to lower muscle strength (Macaluso & De Vito 2004)

7. Handgrip strength
Peak in 4th decade of life and starts to decline around 5th or 6th decade (Kuh et al. 2014)
Relate to gender and height (Leong et al. 2015; Kuh et al. 2005)
Low handgrip strength is predictive of difficulties in everyday tasks like toileting, dressing and doing heavy household work (Rantanen et al. 1999)

8. Example of classification of hand grip strength
Women
Men
Low
17kg
28kg
Medium
25kg
39kg
High
32kg
50kg
Based on participants, median age 50 years, representing low-, middle- and high-income countries over the world
Grip strength measured by Jamar dynamometer
(Leong et al. 2015)

9. Chair stand test
Affected by strength, sensorimotor function, balance, psychological factors such as pain or motivation (Lord et al. 2002)
Obesity and higher weight related with poorer performance (Kuh et al. 2014, Lord et al. 2002)
In general young subjects perform faster on timed chair test (Bohannon et al. 2008; Kuh et al. 2014)
Poor performance or unability to perform predict functional disability in everyday tasks (Kuh et al. 2014)

10. Strengths of physical capability measurements
Both handgrip strength and chair stand tests are
Quick to perform (take less 3 minutes)
Easy
Cheap to perform
Only handgrip strength measurement requires a special device

11. Reporting bias
Objective measurements of physical capability using standardized assessment complement self-report
Objective measurements provide improved
validity and reproducibility
ability to capture change over time
comparability across studies due to reduced impact of cognitive function, culture, language and education
possibility to study the variation across a broader spectrum of function
(Kuh et al. 2014)

12. Acknowledgements
Slides prepared by: Heini Wennman, Hanna Tolonen, Päivikki Koponen
Photographs: Hanna Tolonen
Test demonstrations by voluntary participants
Experiences and feedback from the EHES network have been utilized in the preparation of these slides
Funding: Preparation of the slides is part of the activities of the EHES Coordinating Centre which has received funding from the EC/DG SANTÉ in through SANCO/2008/C2/02-SI EHES and Grand Agreement number , and in through Grand Agreement number /BRIDGE Health

13. Disclaimer
The views expressed here are those of the authors and they do not represent the Commission’s official position.

14. List of references
Bohannon (2008). Hand-grip dynamometry predicts future outcomes in aging adults. Review. J Geriatric Phys Ther: 31(1):3-10 Bohannon et al. (2010). Sit-to-stand test: Performance and determinants across the age-span. Isokinet Eexerc Sci: 18: Bohannon (2015). Muscle strength: clinical and prognostic value of hand-grip dynamometry. Curr Opin Clin Nutr Metab Care: 18: 465 – 470. Cooper et al. (2011). Objective measures of physical capability and subsequent health: a systematic review. Age and Ageing:40:14-23 Kuh et al. (2005). Grip strength, postural control, and functional leg power in a representative cohort of british men and women: Associations with physical activity, health status and socioeconomic conditions. Jour Geront:Medical Sciences: 60A. 2: Kuh et al. (2014). A life course approach to healthy aging: maintaining physical capability. Proceedings of the Nutrition Society. 73: Leong et al. (2015). Prognostic value of grip strength: findings from the Prospective Urban Rural Epidemiology (PURE) study. Lancet: 386: 266–73 Lord et al. (2002). Sit-to-stand performance depends on sensation, speed, balance, and psychological status in addition to strength in older people. J Geront Med Sci : 57A(8):M539-M543 Macaluso & De Vito (2004). Muscle strength, power and adaptations to resistance training in older adults. Eur J Appl Phys: 91: 4: Rantanen et al. (1999). Midlife hand grip strength as a predictor of old age disability. JAMA: 281: Silventoinen et al. (2008). Heritability of body size and muscle strength in young adulthood: A study of one million Swedish men. Genet Epidemiol:32: Tiainen et al. (2004). Heritability of maximal isometric muscle strength in older female twins. J App Phys: 26: