Elsevier

Clinical Biomechanics

Volume 73, March 2020, Pages 162-165
Clinical Biomechanics

Maximal handgrip strength can predict maximal physical performance in patients with chronic fatigue

https://doi.org/10.1016/j.clinbiomech.2020.01.003Get rights and content

Highlights

  • Patients with chronic fatigue have often difficulties to perform a maximal exercise test.

  • Maximal handgrip strength was used to predict maximal exercise performance.

  • We explored 98 severely fatigued patients, 66 of them with chronic fatigue syndrome.

  • Handgrip strength was correlated with peak values of oxygen uptake and work rate.

  • Thus, handgrip strength is helpful when an ergometric cycle test cannot be performed.

Abstract

Background

Maximal handgrip strength is used to predict exercise performance in healthy older subjects and in patients with chronic obstructive pulmonary disease, breast cancer or cirrhosis. Our objective was to evaluate the ability of maximal handgrip strength to predict maximal exercise performance in patients with chronic fatigue.

Methods

Sixty-six patients with myalgic encephalomyelitis/chronic fatigue syndrome and 32 patients with chronic fatigue but no diagnosis of myalgic encephalomyelitis/chronic fatigue syndrome were included. The maximal physical performance was measured on a cycle ergometer to measure the peak oxygen uptake and the maximal work rate. We searched for linear regressions between maximal handgrip strength and maximal performances.

Findings

No significant differences in slopes and ordinates of regression lines were noted between patients with or without a diagnosis of myalgic encephalomyelitis/chronic fatigue syndrome, allowing to pool the data. Maximal handgrip strength was significantly and positively correlated with peak oxygen uptake and maximal work rate in all patients with chronic fatigue.

Interpretation

We conclude that handgrip strength can predict maximal exercise performance in patients with chronic fatigue.

Introduction

In patients with chronic fatigue, the diagnosis of myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is based on a combination of clinical symptoms including profound fatigue for at least 6 months, cognitive dysfunction, sleep problems, autonomic manifestations, pain, post-exertional malaise and other symptoms that are made worse by exertion (Evengard et al., 1999; Prins et al., 2006; de Korwin et al., 2016). ME/CFS can severely impair a patient's quality of life. We already proposed the evaluation of maximal exercise performance of patients with chronic fatigue. Indeed, in ME/CFS patients submaximal or maximal exercise allows to show abnormalities of muscle excitation and increased oxidative stress (Fenouillet et al., 2016; Jammes et al., 2005, Jammes et al., 2009).

Maximal exercise performances are characterized by the peak oxygen uptake (VO2max) and the maximal work rate (Wmax). More recently, we added the measurement of the maximal handgrip strength (MHGS). This protocol was applied to all patients suffering from chronic bodily fatigue and additional recording of an imbalance of the oxidant/anti-oxidant status at exercise allowed to support the ME/CFS diagnosis.

The exercise trial allowing to reach the maximal or submaximal physical performances is not easy to perform by severely tired patients. Thus, other tools have been proposed to evaluate the maximal strength of some muscle groups. MHGS measurement was already used to approach the global physical activity in different pathologies and also in healthy subjects. The association between cognitive performance and physical activity level (MHGS, cycle ergometer test) has been studied in 31 women with ME/CFS (Ickmans et al., 2013) and the relationship between the sleep efficiency and MHGS was investigated in 42 other female patients (Aerenhouts et al., 2015). Another study in patients with all-cause, cardiovascular, and cancer mortality found a correlation between MHGS and mortality rate (Yates et al., 2017). However, the studies cited above did not investigate the correlation between MHGS and the maximal exercise performance. On the other hand, MHGS and/or maximal quadriceps muscle strength have already been used to predict exercise performance in patients with chronic obstructive pulmonary disease (COPD) (Rausch-Osthoff et al., 2014), breast cancer (Owusu et al., 2017) and cirrhosis (Alvares-da-Silva and Reverbel da Silveira, 2005; Ciocîrlan et al., 2017). In healthy older subjects, MHGS is predictive of a decline in cognition, mobility and functional status (Martien et al., 2015; Rijk et al., 2016). A recent study in a large cohort of older women showed that the handgrip strength predicted the risk of all-cause and cardiovascular disease mortality (Karlsen et al., 2017).

The present retrospective study was carried out to investigate the relationship between MHGS and maximal physical performance (VO2max and maximal work rate or Wmax) of patients with ME/CFS and in a group of patients suffering from severe chronic fatigue accompanying different general pathologies where the ME/CFS diagnostic criteria were not validated. Our aim was to determine whether MHGS is a feasible alternative to the exercise test when the latter cannot be performed in the cases of severe bodily fatigue.

Section snippets

Study population

The study population consisted of 66 patients with at least four symptoms compatible with a diagnosis of ME/CFS (Evengard et al., 1999; Prins et al., 2006) and also an altered muscle excitability and disorders of the oxidant/anti-oxidant status at exercise. The clinical examination of all patients included a questionnaire based on items given by different authors (Evengard et al., 1999; Prins et al., 2006) allowing to validate at least four criteria to establish the ME/CFS diagnosis (fatigue

Results

The physical and physiological characteristics of the patients who took part in the study are summarised in Table 1. The sex ratio was significantly higher in ME/CFS patients (higher proportion of females). However, there was no significant difference between females and males. The majority of our patients were able to reach high work rate levels. On the other hand, there was a large inter-individual scattering of VO2max, maximal work rate and also MHGS in both groups of patients. No

Discussion

The present study indicates that in ME/CFS patients, as well as in patients with chronic fatigue without a ME/CFS diagnosis, measurement of MHGS is useful to approach both their maximal work rate and VO2max. MHGS could therefore be a useful tool to evaluate the maximal physical performance in severely disabled patients who have difficulties to exercise or in the absence of a suitable exercise device.

This study demonstrates the predictive value of MHGS for maximal physical capacities. This has

Conclusion

When an ergometric cycle test cannot be easily performed, the simple, low cost MHGS measurement may be useful to evaluate the maximal physical performance of patients with chronic fatigue, including those with ME/CFS. However, in ME/CFS patients, the sole MHGS measurement cannot replace the information given by a maximal exercise test that is the altered muscle membrane excitability and the associated increase in exercise-induced oxidative stress. MHGS can be used as a screening tool for

Funding sources

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Declaration of competing interest

None to declare.

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