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Multicenter Study
. 2015 Aug;63(8):1628-33.
doi: 10.1111/jgs.13529. Epub 2015 Jul 22.

Lower Extremity Proximal Muscle Function and Dyspnea in Older Persons

Carlos A Vaz Fragoso  1   2 , Katy Araujo  1 , Linda Leo-Summers  1 , Peter H Van Ness  1
Affiliations
Multicenter Study

Lower Extremity Proximal Muscle Function and Dyspnea in Older Persons

Carlos A Vaz Fragoso et al. J Am Geriatr Soc. 2015 Aug.

Abstract

Objectives: To evaluate the association between performance on a single chair stand and moderate to severe exertional dyspnea.

Design: Cross-sectional.

Setting: Cardiovascular Health Study.

Participants: Community-dwelling individuals aged 65 and older (N = 4,413; mean age 72.6; female, n = 2,518 (57.1%); nonwhite, n = 199 (4.5%); obese, n = 788 (17.9%); history of smoking, n = 2,410 (54.6%)).

Measurements: Performance on single chair stand (poor (unable to rise without arm use) vs normal (able to rise without arm use)), moderate to severe exertional dyspnea (American Thoracic Society grade ≥2), age, sex, ethnicity, obesity, smoking, frailty status (Fried-defined nonfrail, prefrail, frail), high cardiopulmonary risk (composite of cardiopulmonary diseases and diabetes mellitus), spirometric impairment, arthritis, depression, stroke, and kidney disease.

Results: Poor performance on the single chair stand was established in 369 (8.4%) and moderate to severe exertional dyspnea in 773 (17.5%). Prefrail status was established in 2,210 (50.1%), frail status in 360 (8.2%), arthritis in 2,241 (51.4%), high cardiopulmonary risk in 2,469 (55.9%), spirometric impairment in 1,076 (24.4%), kidney disease in 111 (2.5%), depression in 107 (2.4%), and stroke in 93 (2.1%). In multivariable regression models, poor performance on the single chair stand was associated with moderate to severe exertional dyspnea (unadjusted odds ratio (OR) = 3.48, 95% confidence interval (CI) = 2.78-4.36; adjusted OR = 1.85, 95% CI = 1.41-2.41).

Conclusion: Poor performance on a single chair stand was associated with an adjusted 85% greater likelihood of moderate to severe exertional dyspnea than normal performance. These results suggest that reduced proximal muscle function of the lower extremities is associated with moderate to severe exertional dyspnea, even after adjusting for multiple confounders.

Keywords: chair stand; dyspnea; spirometry.

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Conflict of interest statement

The authors report no conflicts of interest.

Figures

Figure 1
Figure 1
Conceptual model summarizing the proposed associations of poor performance on a single chair stand and frailty with the outcome of moderate-to-severe exertional dyspneaa aThe solid arrows indicate previously established longitudinal associations of frail status (≥3 frailty measures) with reduced mobility and spirometric impairment.– The dotted arrow indicates an association that weakens when frail status is a covariate (see Table 2). The bidirectional arrows indicate that moderate-to-severe exertional dyspnea is itself associated with physical inactivity, which is a frailty component feature and a risk factor for sarcopenia., bProximal muscle function of the lower extremities is the most important factor when performing a chair stand.– cThe phenotype of sarcopenia may include frailty, as defined by the Fried criteria., dIn the multivariable regresion model (see Table 3), having a frail status (≥3 frailty measures) was more strongly associated with moderate-to-severe exertional dyspnea than pre-frail status (1 or 2 frailty measures)—adjusted odds ratios of 3.24 (2.36, 4.45) and 2.30 (1.87, 2.84), respectively. This suggests a stronger association between frailty and exertional dyspnea, as compared with frailty and poor performance on the single chair stand
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