Factors associated with lower quarter performance-based balance and strength tests: a cross-sectional analysis from the project baseline health study

Abstract

Objectives: Physical performance tests are predictive of mortality and may screen for certain health conditions (e.g., sarcopenia); however, their diagnostic and/or prognostic value has primarily been studied in age-limited or disease-specific cohorts. Our objective was to identify the most salient characteristics associated with three lower quarter balance and strength tests in a cohort of community-dwelling adults.

Methods: We applied a stacked elastic net approach on detailed data on sociodemographic, health and health-related behaviors, and biomarker data from the first visit of the Project Baseline Health Study (N = 2,502) to determine which variables were most associated with three physical performance measures: single-legged balance test (SLBT), sitting-rising test (SRT), and 30-second chair-stand test (30CST). Analyses were stratified by age (<65 and ≥65).

Results: Female sex, Black or African American race, lower educational attainment, and health conditions such as non-alcoholic fatty liver disease and cardiovascular conditions (e.g., hypertension) were consistently associated with worse performance across all three tests. Several other health conditions were associated with either better or worse test performance, depending on age group and test. C-reactive protein was the only laboratory value associated with performance across age and test groups with some consistency.

Conclusions: Our results highlighted previously identified and several novel salient factors associated with performance on the SLBT, SRT, and 30CST. These tests could represent affordable, noninvasive biomarkers of prevalent and/or future disease in adult individuals; future research should validate these findings.

Clinical trial registration: ClinicalTrials.gov, identifier NCT03154346, registered on May 15, 2017.

Keywords: 30-second chair-stand test; biomarkers; community-dwelling adults; physical functional performance; project baseline health study; single-legged balance test; sitting-rising test.

Figure 1

Kernel density ridgeline plots of age-stratified physical performance results. (A) Single-legged balance test; (B): sitting-rising test; (C): 30-s chair-stand test.

Figure 2

Top 20 regression coefficients of features selected from sENET regression model for single legged balance test. (A) Participants <65 years of age (ɑ = 1, λ = 0.0025); (B): participants ≥65 years of age (ɑ = 1, λ = 0.334). PTSD, posttraumatic stress disorder; BMI, body mass index; HDL, high density lipoprotein.

Figure 3

Top 20 regression coefficients of features selected from sENET regression model for sitting rising score. (A) Participants <65 years of age (ɑ = 1, λ = 0.023); (B): participants ≥65 years of age (ɑ = 1, λ = 0.038). BMI, body mass index; HbA1c, hemoglobin A1c; MPV = ; PE, pulmonary embolism; DVT, deep venous thrombosis; GFR MDRD, estimated glomerular filtration rate, modification of diet in renal disease study equation.

Figure 4

Top 20 regression coefficients of features selected from sENET regression model for 30-s chair stand test. (A) Participants <65 years of age (ɑ = 0.5, λ = 0.0238); (B): participants ≥65 years of age (ɑ = 0.5, λ = 0.0752). PTSD, posttraumatic stress disorder; GERD, gastroesophageal reflux disease; COPD, chronic obstructive pulmonary disease.