ABSTRACT Background: The ability to climb stairs (ascending and descending stair without using a handrail) and rise from a chair (rising from chairs without using an elbow rest) are among the most important measures of physical function for ADL evaluation for the independent living, and assessed by the questioners on many epidemiological studies in elderly. But little is known about the relationship between the self-reported performance level of the tasks and lower leg strength and power in very elderly people. The purpose of this study was to ascertain the relationship between the self-reported performance level of two tasks and the lower leg function in community-dwelling 80-year-old population. Methods: Out of 994 persons who were 80 years old living in Morioka City, Iwate Prefecture, Japan, 607 individuals (236 men and 371 women) underwent a physical fitness test that included measurements of leg extensor power and knee extensor strength. The ability to climb up stair and to rise from a chair was assessed by self- reported questionnaire which was ranked in three levels. The area under the receiver-operating characteristic (ROC) curve (AUC) was used to evaluate the measurements. Results: The cut-off points for the leg extensor power of subjects who could completely perform the stair-climbing and chair-rising functions were determined to be approximately 8.6 watt/kg body mass for men and 5.6 watt/kg body mass for women. In addition, the cut-off points for the knee extensor strength of subjects who could completely perform the stair-climbing and chair-rising functions were determined to be approximately 0.97 kg/kg body mass for men and 0.84 kg/kg body mass for women. Conclusions: From a practical viewpoint, the present study suggested that the cut-off points of leg extensor power and knee extensor strength can be used as targets in simple self-reported questionnaires to help in screening for mobility in 80-year-old population
Cite this paper
Shimada, M. , Nomura, Y. , Kimura, Y. , Nakagawa, N. , Nagayama, H. , Tazawa, M. , Sato, T. , Inaba, D. , Yonemitsu, M. and Yoshitake, Y. (2012) Functional performance levels of strength and power needed for independence in 80-year-old individuals. Open Journal of Epidemiology, 2, 61-69. doi: 10.4236/ojepi.2012.23010.
 Gill, T.M., Williams, C.S. and Tinetti, M.E. (1995) Assessing risk for the onset of functional dependence among older adults: The role of physical performance. Journal of the American Geriatrics Society, 43, 603-609.
Guralnik, J.M., Ferrucci, L., Simonsick, E.M., Salive, M.E. and Wallace, R.B. (1995) Lower-extremity function in persons over the age of 70 years as a predictor of subsequent disability. The New England Journal of Medicine, 332, 556-561. doi:10.1056/NEJM199503023320902
Startzell, J.K., Owens, A., Mulfinger, L.M. and Cavanagh, P.R. (2000) Stair negotiation in older people: A review. Journal of the American Geriatrics Society, 48, 567-580.
Guralnik, J.M., Simonsick, E.M., Ferrucci, L., Glynn, R.J., Berkman, L.F., Blazer, D.G., Scherr, P.A. and Wallace, R.B. (1994) A short physical performance battery assessing lower extremity function: Association with self-reported disability and prediction of mortality and nursing home admission. Journal of Gerontology, 49, M85-M94.
Verghese, J., Wang, C., Xue, X. and Holtzer, R. (2008) Self-reported difficulty in climbing up or down stairs in nondisabled elderly. Archives of Physical Medicine and Rehabilitation, 89, 100-104. doi:10.1016/j.apmr.2007.08.129
Morley, J.E. (2003) Mobility performance: A high-tech test for geriatricians. The Journals of Gerontology, Series A, 58A, 712-714. doi:10.1093/gerona/58.8.M712
Ferrucci, L. (2008) The Baltimore Longitudinal Study of Aging (BLSA): A 50-year-long journey and plans for the future. The Journals of Gerontology. Series A, Biological Sciences and Medical Sciences, 63A, 1416-1419. doi:10.1093/gerona/63.12.1416
Bassey, E.J., Bendall, M.J. and Pearson, M. (1998) Muscle strength in the triceps surae and objectively measured customary walking activity in men and women over 65 years of age. Clinical Science, 74, 85-89.
Rantanen, T., Era, P. and Heikkinin, E. (1996) Maximal isometric knee extension strength and stair-mounting ability in 75- and 80-year-old men and women, Scandinavian Journal of Rehabilitation Medicine, 28, 89-93.
Danneskiold-Samse, B., Kofod, V., Munter, J., Grimby, G., Schnohr, P. and Jensen, G. (1984) Muscle strength and functional capacity in 78-81-year-old men and women. European Journal of Applied Physiology and Occupational Physiology, 52, 310-314. doi:10.1007/BF01015216
Plotz-Snyder, L.L., Manini, T., Plotz-Snyder, R.J. and Wolf, D.A. (2002) Functionally relevant thresholds of quadriceps femoris strength. The Journals of Gerontology. Series A, Biological Sciences and Medical Sciences, 57A, B144-B152. doi:10.1093/gerona/57.4.B144
Ferrucci, L., Guralnik, J.M. and Buchner, D. (1997) Departures from linearity in the relationship between measures of muscular strength and physical performance of the lower extremities: The women’s health and aging study. The Journals of Gerontology. Series A, Biological Sciences and Medical Sciences, 52A, M275-M285. doi:10.1093/gerona/52A.5.M275
Bassey, E.J., Fiatarone, M.A., O’Neill, E.F., Kelly, M., Evans, W.J. and Lipsitz, L.A. (1992) Leg extensor power and functional performance in very old men and women. Clinical Science, 82, 321-327.
Lauretani, F., Russo, C.R., Bandinelli, S., Bandinelli, S., Bartali, B., Cavazzini, C., Iorio, A.D., Corsi, A.M., Rantanen, T., Guralnik, J.A. and Ferrucci, L. (2003). Ageassociated changes in skeletal muscle and their effect on mobility: An operational diagnosis of sarcopenia. Journal of Applied Physiology, 95, 1851-1860.
Cress, M.E. and Meyer, M. (2003) Maximal voluntary and functional performance levels needed for independence in adults aged 65 to 97 years. Physical Therapy, 83, 37-48.
Buchner, D.M. and Lateur, B.J. (1991) The importance of skeletal muscle strength to physical function in older adults. Annals of Behavioral Medicine, 13, 91-98.
Young, A. and Skelton, D.A. (1994) Applied physiology of strength and power in old age. International Journal of Sports Medicine, 15, 149-151. doi:10.1055/s-2007-1021037
Hasegawa, R., Ialam, M.M., Lee, S.C., Koizumi, D., Rogers, M.E. and Takeshita, N. (2008) Threshold of lower body muscular strength necessary to perform ADL independently in community-dwelling older adults. Clinical Rehabilitation, 22, 902-910. doi:10.1177/0269215508094713
Kennedy, D., Stratford, P.W., Pagura, S.M.C., Walsh, M. and Woodhouse, L.J. (2002) Comparison of gender and group differences in self-report and physical performance measures in total hip and knee arthroplasty candidates. The Journal of Arthroplasty, 17, 70-77. doi:10.1054/arth.2002.29324
Ito, M. and Yoda, Y. (1992) Development of an apparatus to measure instantaneous leg extensor power output. The Japanese Journal of Physical Fitness and Sports Medicine, 11, 742-746 (in Japanese with English abstract).
Hirano, Y., Noguchi, T. and Miyashita, M. (1994) The explosive leg extensor power output and its evaluation with the function of sex and age. The Japanese Journal of Physical Fitness and Sports Medicine, 43, 113-120 (in Japanese with English abstract).
Hanley, J.A. and McNeil, B.J. (1983) A method of comparing the areas under receiver operating characteristic curves derived from the same cases. Radiology, 148, 839- 843.
Toba, K., Okochi, J. and Takahashi, T. (2005) Development of a portable fall risk index for elderly people living in the community. Japanese Journal of Geriatrics, 42, 346-352. doi:10.3143/geriatrics.42.346
Kondo, K., Tanaka, T., Hirota, Y., Kawamura, H., Miura, H., Sugioka, Y., Inoue, H., Kurosawa, M. and Yamashita, T. (2006) Factors associated with functional limitation in stair climbing in female Japanese patients with knee osteoarthritis. Journal of Epidemiology/Japan Epidemiological Association, 16, 21-29.
Bean, J.F., Leveille, S.G., Kiely, D.K., Bandinelli, S., Guralnik, J.M. and Ferrucci, L. (2003) A comparison of leg power and leg strength within the InCHIANTI study: Which influences mobility more? Journal of Gerontology: Medical Sciences, 58A, 728-733. doi:10.1093/gerona/58.8.M728
Rantanen, T., Era, P. and Heikkinen, E. (1994) Maximal isometric strength and mobility among 75-year-old men and women. Age and Ageing, 23, 132-137. doi:10.1093/ageing/23.2.132
Guralnik, J.M. and Ferrucci, L. (2003) Assessing the building blocks of function: Utilizing measures of functional limitation. American Journal of Preventive Medicine, 25, 112-121. doi:10.1016/S0749-3797(03)00174-0
Suzuki, T., Bean, J.F. and Fielding, R.A. (2001) Muscle power of the ankle flexors predicts functional performance in community-dwelling older women. The Journal of the American Society for Geriatric Dentistry, 49, 1161-1167. doi:10.1046/j.1532-5415.2001.49232.x
Morey, M.C., Pieper, C.F. and Cornoni-Huntley, J. (1998) Is there a threshold between peak oxygen uptake and self-reported physical functioning in older adults? Medicine and Science in Sports and Exercise, 30, 1223-1229. doi:10.1097/00005768-199808000-00007
Posner, J.D., McCully, K.K., Landsberg, L.A., Sands, L.P., Tycenski, P., Hofmann, M.T., Wetterholt, K.L. and Shaw, C.E. (1995) Physical determinants of independence in mature women. Archives of Physical Medicine and Rehabilitation, 76, 373-380. doi:10.1016/S0003-9993(95)80664-4
Brechter, J.H. and Powes, C.M. (2002) Patellofemoral joint stress during stair ascent and descent in persons with and without patellofemoral pain. Gait Posture, 16, 115-123. doi:10.1016/S0966-6362(02)00090-5
Papa, E. and Cappozzo, A. (2000) Sit-to-stand motor strategies investigated in able-bodied young and elderly subjects. Journal of Biomechanics, 33, 1113-1122.