DIFFERENT TOOLS TO ASSESS GLOBAL MUSCLE STRENGTH IN OLDER WOMEN WITH AND WITHOUT A HISTORY OF CANCER

J. Mello Porto¹, A.C. Lima Bandeira¹, F. Maris Peria², O.L. Sena Almeida³, E. Ferrioli³, D.C. Carvalho de Abreu⁴

¹Ribeirão Preto School of Medicine, University of São Paulo (FMRP-USP), Program in Rehabilitation and Functional Performance, Ribeirão Preto, Brazil, ²Ribeirao Preto Medical School, at the University of São Paulo (FMRP-USP), Medical Imaging, Hematology and Oncology, Ribeirão Preto, Brazil, ³Ribeirão Preto Medical School of the University of São Paulo (USP), Internal Medicine, Geriatric Division, Ribeirão Preto, Brazil, ⁴Ribeirao Preto Medical School, at the University of São Paulo (FMRP-USP), Health Sciences, Ribeirao Preto, Brazil

Background: Muscle weakness in older adults, especially in the lower limbs, has been associated with impaired mobility and increased risk of falls and functional decline. Tests such as handgrip strength and forward step have been identified in the literature as screening tools for global muscle weakness in older adults. Older people with cancer are at greater risk of developing muscle weakness due to a combination of factors of the aging process itself, the disease, and cancer treatment. Among the treatments, chemotherapy is highly associated with functional decline, from the beginning of treatment to even many years after the end of the treatment. However, the best test to screen for muscle weakness in this population is not known.

Purpose: To compare global muscle strength among older women with a history of cancer who completed chemotherapy (no more than 5 years ago) (G1) and without a history of cancer (G2), using 2 different screening tools: handgrip strength (HG) and forward step test (ST). In addition, to verify whether these different tests to assess global muscle strength are similar for identifying muscle weakness in older women cancer survivors.

Methods: Thirty-four older women (G1 = 17 and G2 = 17) underwent indirect assessment of global muscle strength through HS (using a handgrip dynamometer - Jamar, Sammons Preston, Illinois, measured in Kgf) and ST (the highest step that a participant could climb without assistance, measured in cm). The HS and ST performances between the groups were compared using the analysis of variance (ANOVA), considering the confounding variables age and body mass index, in the SPSS (version 25.0) statistical program. The difference was considered significant if p < 0.05.

Results: There was no difference between groups in HS (F_{(1, 30)} = 0.12; η²⁼ 0.004; p = 0.729; G1 = 19.66±6.10 Kgf ; G2 = 20.45±6.05 Kgf). There was a significant difference between groups in the ST (F_{(1, 30)} = 17.34; η² = 0.36; p < 0.001), with G1 showing worse performance (15.00±12.62 cm) than G2 (34.70±10.37 cm).

Conclusions: Older women cancer survivors who completed chemotherapy had worse functional lower limb muscle strength than older women without a history of cancer or chemotherapy, but no differences were identified in global muscle strength by handgrip strength. These results suggest that the forward step test may be more appropriate for identifying muscle weakness in older women cancer survivors.

Implications: Identifying muscle weakness in older women cancer survivors is critical to preventing functional decline. However, no studies were found that investigated the best muscle weakness screening tool in this population. From our results, it appears that the ST is a more appropriate muscle weakness screening tool to be applied in clinical practice in older women cancer survivors.

Funding acknowledgements: The first author (post-doctoral student) had scholarship provided by Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq) – Brazil.

Keywords:
Muscle weakness
Chemotherapy
Functional decline

Topics:
Older people
Musculoskeletal
Professional practice: other

Did this work require ethics approval? Yes

Institution: Ribeirão Preto Medical School – University of São Paulo

Committee: Local Human Research Ethics Committee

Ethics number: CAAE: 47206121.5.0000.5440