Physical Therapy Korea
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Phys. Ther. Korea 2023; 30(3): 202-210
Published online August 20, 2023
https://doi.org/10.12674/ptk.2023.30.3.202
© Korean Research Society of Physical Therapy
Relationship Between Muscle Mass and Usual Walking Speed Mediated by Muscle Strength, Respiration and Depression in Elderly Female
Yun-jeong Baek1 
, PT, MSc, Chung-hwi Yi2 , PT, PhD, Oh-yun Kwon2 , PT, PhD, Sang-hyun Cho2 , MD, PhD
1Department of Rehabilitation Medicine, Seoul National University Bundang Hospital, Seongnam, 2Department of Physical Therapy, College of Health Sciences, Yonsei University, Wonju, Korea
Correspondence to: Chung-hwi Yi
E-mail: pteagle@yonsei.ac.kr
https://orcid.org/0000-0003-2554-8083
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Background: The elderly population is increasing rapidly worldwide. Muscle mass, usual walking speed (UWS), knee extension strength (KES), hand grip strength (HGS), peak expiratory flow (PEF), and depression is used for sarcopenia diagnosis. All four of these factors (KES, HGS, PEF, and depression) correlated with UWS and also to muscle mass. But, many studies have suggested that no correlation exists between muscle mass and UWS. Objects: This study aimed: 1) to investigate whether muscle mass reduction affected UWS, as mediated by KES, HGS, PEF and depression, and 2) to explored whether significant changes in these mediators varied by the body segment in which muscle mass evaluated in elderly female aged 65–80 years.
Methods: A total of 100 female aged 65–80 years were surveyed. Muscle mass was measured by body segment (upper and lower segment), and KES, HGS, PEF, depression, and UWS were also assessed. Median analyses were progressed in IBM SPSS software (ver. 23.0, IBM Co.) using a downloaded INDIRECT macro.
Results: The direct effect of the KES and PEF were significant, and the indirect effect of KES and PEF were not significant. Thus, KES and PEF served as full mediators of the effect of muscle mass on UWS. Regardless of bodily region, KES and PEF combined with muscle mass were significant mediators of UWS, with similar indirect effect sizes.
Conclusion: KES and PEF are the only mediators regardless of body part. Therefore, mediating the KES and PEF may prevent sarcopenia progression in elderly female. Also, sarcopenia can be readily assessed by evaluating either the upper or lower body; it is not necessary to measure total muscle mass.
Keywords: Aged, Muscle mass, Muscle strength, Sarcopenia, Walking speed
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Original Article
Phys. Ther. Korea 2023; 30(3): 202-210
Published online August 20, 2023 https://doi.org/10.12674/ptk.2023.30.3.202
Copyright © Korean Research Society of Physical Therapy.
Relationship Between Muscle Mass and Usual Walking Speed Mediated by Muscle Strength, Respiration and Depression in Elderly Female
Yun-jeong Baek1 , PT, MSc, Chung-hwi Yi2 , PT, PhD, Oh-yun Kwon2 , PT, PhD, Sang-hyun Cho2 , MD, PhD
1Department of Rehabilitation Medicine, Seoul National University Bundang Hospital, Seongnam, 2Department of Physical Therapy, College of Health Sciences, Yonsei University, Wonju, Korea
Correspondence to:Chung-hwi Yi
E-mail: pteagle@yonsei.ac.kr
https://orcid.org/0000-0003-2554-8083
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract
Background: The elderly population is increasing rapidly worldwide. Muscle mass, usual walking speed (UWS), knee extension strength (KES), hand grip strength (HGS), peak expiratory flow (PEF), and depression is used for sarcopenia diagnosis. All four of these factors (KES, HGS, PEF, and depression) correlated with UWS and also to muscle mass. But, many studies have suggested that no correlation exists between muscle mass and UWS. Objects: This study aimed: 1) to investigate whether muscle mass reduction affected UWS, as mediated by KES, HGS, PEF and depression, and 2) to explored whether significant changes in these mediators varied by the body segment in which muscle mass evaluated in elderly female aged 65–80 years.
Methods: A total of 100 female aged 65–80 years were surveyed. Muscle mass was measured by body segment (upper and lower segment), and KES, HGS, PEF, depression, and UWS were also assessed. Median analyses were progressed in IBM SPSS software (ver. 23.0, IBM Co.) using a downloaded INDIRECT macro.
Results: The direct effect of the KES and PEF were significant, and the indirect effect of KES and PEF were not significant. Thus, KES and PEF served as full mediators of the effect of muscle mass on UWS. Regardless of bodily region, KES and PEF combined with muscle mass were significant mediators of UWS, with similar indirect effect sizes.
Conclusion: KES and PEF are the only mediators regardless of body part. Therefore, mediating the KES and PEF may prevent sarcopenia progression in elderly female. Also, sarcopenia can be readily assessed by evaluating either the upper or lower body; it is not necessary to measure total muscle mass.
Keywords: Aged, Muscle mass, Muscle strength, Sarcopenia, Walking speed
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Table 1 . Subject characteristics.
Variable Participant (N = 100) Age (y) 72.4 ± 4.9 Height (cm) 152.2 ± 5.6 Weight (kg) 58.4 ± 8.6 Body mass index (kg/m2) 25.2 ± 3.3 Hypertension 50 Diabetes 17 Smoking 2 Back pain 37 Knee pain 23 Depression 7 Values are presented as mean ± standard deviation or number only..
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Table 2 . Results of Pearson correlation coefficients between independent variables.
Variable KES HGS PEF Depression Mean ± SD KES 1 21.09 ± 6.07 HGS 0.623** 1 22.88 ± 5.03 PEF 0.023* 0.319** 1 5.01 ± 1.32 Depression –0.023* –0.215* –0.311** 1 11.71 ± 5.29 KES, knee extension strength; HGS, hand grip strength; PEF, peak expiratory flow; Mean ± SD, mean ± standard deviation. *p < 0.05, **p < 0.01..
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Table 3 . Mediation of UWS by ULMM via KES, HGS, PEF, and depression.
Variable a path b path Indirect effect (a × b) BC 95% CI Lower Upper Indirect effect KES 0.9932 0.0114 0.0113 0.0033 0.0246* HGS 1.1427 0.0078 0.0089 –0.0043 0.0275 PEF 0.1792 0.0490 0.0088 0.0020 0.0217* Depression –0.3640 –0.0066 0.0024 –0.0003 0.0102 Total 0.0314 0.0153 0.0532 Comparison KES vs HGS 0.0025 –0.0199 0.0230 KES vs PEF 0.0026 –0.0099 0.0155 KES vs Depression 0.0090 –0.0010 0.0226 HGS vs PEF 0.0001 –0.0183 0.0193 HGS vs KES 0.0065 –0.0072 0.0242 PEF vs Depression 0.0064 –0.0027 0.0201 BC, bias-corrected; CI, confidence interval; KES, knee extension strength; HGS, hand grip strength; PEF, peak expiratory flow. *Significant mediator..
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Table 4 . Mediation by UMM of UWS via KES, HGS, PEF, and depression.
Variable a path b path Indirect effect (a × b) BC 95% CI Lower Upper Indirect KES 2.1841 0.0111 0.0242 0.0026 0.0681* HGS 3.4169 0.0103 0.0352 –0.0012 0.0908 PEF 0.4023 0.0503 0.0202 0.0012 0.0567* Depression –0.9016 –0.0066 0.0060 –0.0030 0.0321 Total 0.0856 0.0319 0.1526 Contrast KES vs HGS –0.0111 –0.0743 0.0470 KES vs PEF 0.0039 –0.0346 0.0442 KES vs Depression 0.0182 –0.0100 0.0616 HGS vs PEF 0.0150 –0.0356 0.0736 HGS vs KES 0.0293 –0.0090 0.0815 PEF vs Depression 0.0143 –0.0125 0.0523 BC, bias-corrected; CI, confidence interval; KES, knee extension strength; HGS, hand grip strength; PEF, peak expiratory flow. *Significant mediator..
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Table 5 . The effect of LMM on UWS via KES, HGS, PEF, and depression.
Variable a path b path Indirect effect (a × b) BC 95% CI Lower Upper Indirect KES 1.4303 0.0112 0.0160 0.0052 0.0340* HGS 1.5208 0.0068 0.0104 –0.0078 0.0339 PEF 0.2569 0.0473 0.0122 0.0029 0.0291* Depression –0.5103 0.0042 0.0034 –0.0006 0.0131 Total 0.0419 0.0193 0.0705 Comparison KES vs HGS 0.0057 –0.0241 0.0337 KES vs PEF 0.0038 –0.0241 0.0337 KES vs Depression 0.0126 –0.0010 0.0313 HGS vs PEF –0.0018 –0.0266 0.0241 HGS vs KES 0.0070 –0.0116 0.0301 PEF vs Depression 0.0088 –0.0037 0.0257 BC, bias-corrected; CI, confidence interval; KES, knee extension strength; HGS, hand grip strength; PEF, peak expiratory flow. *Significant mediator..