Quadriceps Strength, Quadriceps Power, and Gait Speed in Older U.S. Adults with Diabetes Mellitus: Results from the National Health and Nutrition Examination Survey, 1999–2002

Abstract

Objectives To examine the independent association of diabetes (and its duration and severity) with quadriceps strength, quadriceps power, and gait speed in a national population of older adults. Design Cross-sectional nationally representative survey. Setting U.S. Participants We examined 2573 adults ≥50 years of age in the National Health and Nutrition Examination Survey 1999–2002 who had assessment of quadriceps strength. Methods Diabetes was ascertained by questionnaire. Measurement of isokinetic knee extensors (quadriceps) strength was performed at 60 degrees/second. Gait speed was assessed using a 20-foot walk test. Multiple linear regression analyses were used to assess the association between diabetes status and outcomes, adjusting for potential confounders or mediators. Results Among older U.S. adults, those with versus without diabetes had significantly slower gait speed (0.96±0.02 versus 1.08±0.01 m/s; p<0.001). After adjusting for demographics, weight, and height, diabetes was also associated with significantly lower quadriceps strength (−4.6±1.9 Newton-meters; p=0.02), quadriceps power (−4.9±2.0 Watts; p=0.02), in addition to gait speed (−0.05±0.02 m/s; p=0.002). Associations remained significant after adjusting for physical activity and C-reactive protein. After accounting for comorbidities (cardiovascular disease, peripheral neuropathy, amputation, cancer, arthritis, fracture, COPD), diabetes was only independently associated with gait speed (−0.04±0.02 m/s; p=0.02). Diabetes duration in men and women was negatively associated with age-adjusted quadriceps strength (−5.7 and −3.5 Newton-meters/decade of diabetes, respectively) and power (−6.1 and −3.8 Watts/decade of diabetes, respectively) (all p≤0.001, no significant interactions by gender). Hemoglobin A1c was not associated with outcomes accounting for body weight. Conclusion Compared to persons without diabetes, older U.S. adults with diabetes have lower quadriceps strength and quadriceps power that is related to the presence of comorbidities. Persons with diabetes also walk slower. Future studies should investigate the relationship of hyperglycemia with subsequent declines in leg muscle function.

Factores asociados a velocidad de marcha lenta en adultos mayores de un distrito en Lima, Perú

“…Un estudio demostró que la diabetes estaba asociada a una menor densidad y calidad muscular y menor fuerza en la rodilla y el tobillo (28) y también a una menor distancia de recorrido en 6 min (29) . Asimismo, se considera que la presencia del estado proinflamatorio como consecuencia de la resistencia a la insulina, producirá una reducción en la fuerza y poder muscular, lo cual, aunado a la neuropatía periférica, explicarían aún más la presencia de una velocidad de la marcha lenta en adultos mayores diabéticos (30) . La población estudiada fue extraída de la comunidad, y con una deambulación sin asistencia, por lo que no se incluyó adultos mayores con diabetes que haya producido daño secuelar a nivel de miembros inferiores o sobre la capacidad cardiaca, respiratoria o neurológica que altere la marcha.…”

Diabetes and Risk of Frailty and Its Potential Mechanisms: A Prospective Cohort Study of Older Adults

“…In this regard, previous studies linking diabetes with reduced walking speed (39,(43)(44)(45) have attributed this association to the accelerated loss of skeletal muscle strength that is commonly seen in older adults with this metabolic disease (23,24). To address whether diabetes-related muscle impairments could mediate the association between diabetes and low walking speed, researchers from the InCHIANTI study assessed walking performance and lower-extremity muscle mass, strength and power in a sample of 835 older adults (43).…”

Poor toe flexor strength, but not handgrip strength, is associated with the prevalence of diabetes mellitus in middle-aged males

“…A lower amount of physical activity is a risk factor for type-2 diabetes mellitus [36], and gait speed is associated with the prevalence of diabetes mellitus [22,37]. TFS is positively related to physical activity [20,38].…”

“…One cross-sectional study also showed that poor muscular strength and power of lower-limb muscle groups are associated with the prevalence of diabetes mellitus [22]. One longitudinal study suggested that poor muscular strength (as quantified by a combination of leg and bench presses) is a risk factor for the metabolic syndrome [23].…”