BACKGROUND: Weak muscle strength has been associated with a wide range of adverse health outcomes. Yet, whether individuals with weaker muscle strength are more at risk for hospitalization due to severe COVID-19 is still unclear. The objective of this study was to investigate the independent association between muscle strength and COVID-19 hospitalization. METHODS: Data from adults 50 years of age or older were analysed using logistic models adjusted for several chronic conditions, body-mass index, age, and sex. Hand-grip strength was repeatedly measured between 2004 and 2017 using a handheld dynamometer. COVID-19 hospitalization during the lockdown was self-reported in summer 2020 and was used as an indicator of COVID-19 severity. RESULTS: The study was based on the Survey of Health, Ageing and Retirement in Europe (SHARE) and included 3600 older adults (68.8 ± 8.8 years, 2044 female), among whom 316 were tested positive for the severe acute respiratory syndrome coronavirus 2 (8.8%), and 83 (2.3%) were hospitalized due to COVID-19. Results showed that higher grip strength was associated with a lower risk of COVID-19 hospitalization [adjusted odds ratio (OR) per increase of 1 standard deviation in grip strength = 0.64, 95% confidence interval (95% CI) = 0.45-0.87, P = 0.015]. Results also showed that age (OR for a 10 -year period = 1.70, 95% CI = 1.32-2.20, P < 0.001) and obesity (OR = 2.01, 95% CI = 1.00-3.69, P = 0.025) were associated with higher risk of COVID-19 hospitalization. Sensitivity analyses using different measurements of grip strength as well as robustness analyses based on rare-events logistic regression and a different sample of participants (i.e. COVID-19 patients) were consistent with the main results. CONCLUSIONS: Muscle strength is an independent risk factor for COVID-19 severity in adults 50 years of age or older.

Bruyère Research Institute Ottawa Ontario Canada

Department of Public Mental Health National Institute of Mental Health Klecany Czech Republic

Department of Readaptation and Geriatrics University of Geneva Geneva Switzerland

EpiCentre Department of Psychiatry University of Cambridge Cambridge UK

Institute of Sport Sciences University of Lausanne Lausanne Switzerland

Laboratory for the Study of Emotion Elicitation and Expression Department of Psychology University of Geneva Geneva Switzerland

Population Health Laboratory University of Fribourg Fribourg Switzerland

School of Rehabilitation Sciences Faculty of Health Sciences University of Ottawa Ottawa Ontario Canada

SENS Univ Grenoble Alpes Grenoble France

Swiss Center for Affective Sciences University of Geneva Geneva Switzerland

Swiss NCCR 'LIVES Overcoming Vulnerability Life Course Perspectives' University of Geneva Geneva Switzerland

Zobrazit více v PubMed

WHO . https://covid19.who.int/. Accessed 28 January, 2021.

West EA, Anker D, Amati R, Richard A, Wisniak A, Butty A, et al. Corona Immunitas: study protocol of a nationwide program of SARS‐CoV‐2 seroprevalence and seroepidemiologic studies in Switzerland. Int J Public Health 2020;65:1529–1548. PubMed PMC

Vos ER, den Hartog G, Schepp RM, Kaaijk P, Van Vliet J, Helm K, et al. Nationwide seroprevalence of SARS‐CoV‐2 and identification of risk factors in the general population of the Netherlands during the first epidemic wave. J Epidemiol Community Health 2021;75:489–495. PubMed PMC

Docherty AB, Harrison EM, Green CA, Hardwick HE, Pius R, Norman L, et al. Features of 20 133 UK patients in hospital with covid‐19 using the ISARIC WHO Clinical Characterisation Protocol: prospective observational cohort study. BMJ 2020;369. PubMed PMC

Landi F, Barillaro C, Bellieni A, Brandi V, Carfì A, D'Angelo M, et al. The new challenge of geriatrics: saving frail older people from the SARS‐COV‐2 pandemic infection. J Nutr Health Aging 2020;1:466–470. PubMed PMC

Berlin DA, Gulick RM, Martinez FJ. Severe covid‐19. N Engl J Med 2020;383:2451–2460. PubMed

Jordan RE, Adab P, Cheng K. Covid‐19: risk factors for severe disease and death. BMJ 2020;368:m1198. PubMed

Li X, Xu S, Yu M, Wang K, Tao Y, Zhou Y, et al. Risk factors for severity and mortality in adult COVID‐19 inpatients in Wuhan. J Allergy Clin Immunol 2020;14:110–118. PubMed PMC

CDC . People with certain medical conditions Centers for Disease Control and Prevention. https://www.cdc.gov/coronavirus/2019‐ncov/need‐extra‐precautions/people‐with‐medical‐conditions.html#smoking. Accessed 28 January 2021. 2021.

Burtscher J, Millet GP, Burtscher M. Low cardiorespiratory and mitochondrial fitness as risk factors in viral infections: implications for COVID‐19. Br J Sports Med In press. PubMed

Brawner CA, Ehrman JK, Bole S, Kerrigan D, Parikh S, Lewis B, et al. Maximal exercise capacity is inversely related to hospitalization secondary to coronavirus disease 2019. Mayo Clin Proc 2021;96:32–39. PubMed PMC

Yates T, Razieh C, Zaccardi F, Seidu S, Davies MJ, Khunti K. Obesity, walking pace and risk of severe COVID‐19: analysis of UK Biobank. PubMed DOI PMC

Hewitt J, Carter B, Vilches‐Moraga A, Quinn TJ, Braude P, Verduri A, et al. The effect of frailty on survival in patients with COVID‐19 (COPE): a multicentre, European, observational cohort study. Lancet Public Health 2020;5:e444–e451. PubMed PMC

Leong DP, Teo KK, Rangarajan S, Lopez‐Jaramillo P, Avezum A Jr, Orlandini A, et al. Prognostic value of grip strength: findings from the Prospective Urban Rural Epidemiology (PURE) study. Lancet 2015;386:266–273. PubMed

Wolfe RR. The underappreciated role of muscle in health and disease. Am J Clin Nutr 2006;84:475–482. PubMed

Newman AB, Kupelian V, Visser M, Simonsick EM, Goodpaster BH, Kritchevsky SB, et al. Strength, but not muscle mass, is associated with mortality in the health, aging and body composition study cohort. J Gerontol A Biol Sci 2006;61:72–77. PubMed

Cooper R, Kuh D, Cooper C, Gale CR, Lawlor DA, Matthews F, et al. Objective measures of physical capability and subsequent health: a systematic review. Age Ageing 2011;40:14–23. PubMed PMC

Celis‐Morales CA, Welsh P, Lyall DM, Steell L, Petermann F, Anderson J, et al. Associations of grip strength with cardiovascular, respiratory, and cancer outcomes and all cause mortality: prospective cohort study of half a million UK Biobank participants. BMJ 2018;361:k1651. PubMed PMC

Wang P‐Y, Li Y, Wang Q. Sarcopenia: an underlying treatment target during the COVID‐19 pandemic. Nutrition 2020;84:111104. PubMed PMC

Scherpenzeel A, Axt K, Bergmann M, Douhou S, Oepen A, Sand G, et al. Collecting survey data among the 50+ population during the COVID‐19 outbreak: the Survey of Health, Ageing and Retirement in Europe (SHARE). Survey Res Method 2020;14:217–221.

Cheval B, Boisgontier MP, Orsholits D, Sieber S, Guessous I, Gabriel R, et al. Association of early‐ and adult‐life socioeconomic circumstances with muscle strength in older age. Age Ageing 2018;47:398–407. PubMed PMC

Sayer AA, Dennison EM, Syddall HE, Gilbody HJ, Phillips DIW, Cooper C. Type 2 diabetes, muscle strength, and impaired physical function: the tip of the iceberg? Diabetes Care 2005;28:2541–2542. PubMed

Cheval B, Chabert C, Sieber S, Orsholits D, Cooper R, Guessous I, et al. Association between adverse childhood experiences and muscle strength in older age. Gerontology 2019;65:474–484. PubMed

Cheval B, Orsholits D, Sieber S, Courvoisier DC, Cullati S, Boisgontier MP. Relationship between decline in cognitive resources and physical activity. Health Psychol 2020;39:519–528. PubMed

King G, Zeng L. Logistic regression in rare events data. Political Anal 2001;9:137–163.

Choirat C, Gandrud C, Honaker J, Imai K, King G, Lau O. relogit: rare events logistic regression for dichotomous dependent variables.

Okazaki T, Ebihara S, Mori T, Izumi S, Ebihara T. Association between sarcopenia and pneumonia in older people. Geriatr Gerontol Int 2020;20:7–13. PubMed

Nelke C, Dziewas R, Minnerup J, Meuth SG, Ruck T. Skeletal muscle as potential central link between sarcopenia and immune senescence. EBioMedicine 2019;49:381–388. PubMed PMC

Castaneda C, Charnley JM, Evans WJ, Crim MC. Elderly women accommodate to a low‐protein diet with losses of body cell mass, muscle function, and immune response. Am J Clin Nutr 1995;62:30–39. PubMed

Zhou F, Yu T, Du R, Fan G, Liu Y, Liu Z, et al. Clinical course and risk factors for mortality of adult inpatients with COVID‐19 in Wuhan, China: a retrospective cohort study. Lancet 2020;395:1054–1062. PubMed PMC

Liang W, Guan W, Chen R, Wang W, Li J, Xu K, et al. Cancer patients in SARS‐CoV‐2 infection: a nationwide analysis in China. Lancet Oncol 2020;21:335–337. PubMed PMC

de Lusignan S, Dorward J, Correa A, Jones N, Akinyemi O, Amirthalingam G, et al. Risk factors for SARS‐CoV‐2 among patients in the Oxford Royal College of General Practitioners Research and Surveillance Centre primary care network: a cross‐sectional study. Lancet Infect Dis In press. PubMed PMC

Ohara D, Pegorari MS, dos Santos NO, Silva CD, Oliveira MS, Matos AP, et al. Cross‐sectional study on the association between pulmonary function and sarcopenia in Brazilian community‐dwelling elderly from the amazon region. J Nutr Health Aging 2020;24:181–187. PubMed

Kirwan R, McCullough D, Butler T, de Heredia FP, Davies IG, Stewart C. Sarcopenia during COVID‐19 lockdown restrictions: long‐term health effects of short‐term muscle loss. GeroScience 2020;42:1547–1578. PubMed PMC

Paneroni M, Simonelli C, Saleri M, Bertacchini L, Venturelli M, Troosters T, et al. Muscle strength and physical performance in patients without previous disabilities recovering from COVID‐19 pneumonia. Am J Phys Med Rehabil 2021;100:105–109. PubMed

Petrilli CM, Jones SA, Yang J, Rajagopalan H, O'Donnell L, Chernyak Y, et al. Factors associated with hospital admission and critical illness among 5279 people with coronavirus disease 2019 in New York City: prospective cohort study. BMJ 2020;369:m1966. PubMed PMC

Ko JY, Danielson ML, Town M, Derado G, Greenlund KJ, Kirley PD, et al. Risk factors for COVID‐19‐associated hospitalization: COVID‐19‐associated hospitalization surveillance network and behavioral risk factor surveillance system. Clin Infect Dis In press. PubMed PMC

Tuzun S, Keles A, Yildiran T, Palamar D. Assessment of musculoskeletal pain, fatigue and grip strength in hospitalized patients with COVID‐19. Eur J Phys Rehabil Med In press. PubMed

Chen L‐K, Woo J, Assantachai P, Auyeung TW, Chou MY, Iijima K, et al. Asian Working Group for Sarcopenia: 2019 consensus update on sarcopenia diagnosis and treatment. J Am Med Dir Assoc 2020;21:300–7.e2. PubMed

Clift AK, Coupland CA, Keogh RH, Diaz‐Ordaz K, Williamson E, Harrison EM, et al. Living risk prediction algorithm (QCOVID) for risk of hospital admission and mortality from coronavirus 19 in adults: national derivation and validation cohort study. BMJ 2020;371:m3731. PubMed PMC