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Lower limb muscle strength is associated with poor balance in middle-aged women: linear and nonlinear analyses

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Abstract

Summary

This was the first study investigating both linear associations between lower limb muscle strength and balance in middle-aged women and the potential for thresholds for the associations. There was strong evidence that even in middle-aged women, poorer LMS was associated with reduced balance. However, no evidence was found for thresholds.

Introduction

Decline in balance begins in middle age, yet, the role of muscle strength in balance is rarely examined in this age group. We aimed to determine the association between lower limb muscle strength (LMS) and balance in middle-aged women and investigate whether cut-points of LMS exist that might identify women at risk of poorer balance.

Methods

Cross-sectional analysis of 345 women aged 36–57 years was done. Associations between LMS and balance tests (timed up and go (TUG), step test (ST), functional reach test (FRT), and lateral reach test (LRT)) were assessed using linear regression. Nonlinear associations were explored using locally weighted regression smoothing (LOWESS) and potential cut-points identified using nonlinear least-squares estimation. Segmented regression was used to estimate associations above and below the identified cut-points.

Results

Weaker LMS was associated with poorer performance on the TUG (β −0.008 (95 % CI: −0.010, −0.005) second/kg), ST (β 0.031 (0.011, 0.051) step/kg), FRT (β 0.071 (0.047, 0.096) cm/kg), and LRT (β 0.028 (0.011, 0.044) cm/kg), independent of confounders. Potential nonlinear associations were evident from LOWESS results; significant cut-points of LMS were identified for all balance tests (29–50 kg). However, excepting ST, cut-points did not persist after excluding potentially influential data points.

Conclusions

In middle-aged women, poorer LMS is associated with reduced balance. Therefore, improving muscle strength in middle-age may be a useful strategy to improve balance and reduce falls risk in later life. Middle-aged women with low muscle strength may be an effective target group for future randomized controlled trials.

Trial registration

Australian New Zealand Clinical Trials Registry (ANZCTR) NCT00273260.

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Authors and Affiliations

  1. Menzies Institute for Medical Research, University of Tasmania, Private Bag 23, Hobart, TAS, Australia

    F. Wu, M. Callisaya, L. L. Laslett, K. Wills, Y. Zhou, G. Jones & T. Winzenberg

  2. Faculty of Health, University of Tasmania, Hobart, TAS, Australia

    T. Winzenberg

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  1. F. Wu
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  2. M. Callisaya
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  3. L. L. Laslett
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  4. K. Wills
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  5. Y. Zhou
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  6. G. Jones
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  7. T. Winzenberg
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Corresponding author

Correspondence to T. Winzenberg.

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Funding

This work was funded by the National Health and Medical Research Council (NMHRC) project grant (grant number APP1003437) and RACGP/Osteoporosis Australia Bone Health Research Grant.

MC is supported by an NHMRC Early Career Fellowship. TW was supported by NHMRC/PHCRED Career Development Fellowship (grant number APP102859) and GJ is supported by NHMRC Practitioner Fellowship. LL is supported by an Arthritis Foundation Australia—Australian Rheumatology Association (AFA–ARA) Heald Fellowship, funded by the Australian Rheumatology Association and Vincent Fairfax Family Foundation; and a NMHRC Early Career Fellowship (Australian Clinical Research Fellowship) (grant number APP1070586).

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

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Wu, F., Callisaya, M., Laslett, L.L. et al. Lower limb muscle strength is associated with poor balance in middle-aged women: linear and nonlinear analyses. Osteoporos Int 27, 2241–2248 (2016). https://doi.org/10.1007/s00198-016-3545-3

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  • DOI: https://doi.org/10.1007/s00198-016-3545-3

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