Ann Rehabil Med.  2023 Apr;47(2):129-137. 10.5535/arm.22138.

Phase Angle Is Associated With Handgrip Strength in Older Patients With Heart Failure

Affiliations
  • 1Department of Rehabilitation, Kure Kyosai Hospital, Kure, Japan
  • 2Department of Neuromechanics, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
  • 3Department of Rehabilitation, Faculty of Rehabilitation, Hiroshima International University, Higashihiroshima, Japan

Abstract


Objective
To assess the relationships between phase angle and muscle mass, strength, and physical function in patients with heart failure.
Methods
This study used a cross-sectional design. The analysis included 51 patients with heart failure. The Short Physical Performance Battery, one-leg standing time, handgrip strength, phase angle, and skeletal muscle index were measured. To identify explanatory variables of phase angle, hierarchical multiple regression analysis was performed.
Results
Handgrip strength was found to be an explanatory variable of phase angle independent of age, sex, and body mass index. This model was able to explain 30.4% of the model variance for phase angle.
Conclusion
In patients with heart failure, improving muscle strength rather than muscle mass or physical function might be more important for improving phase angle. Handgrip strength is an important outcome for improving prognosis in patients with heart failure.

Keyword

Heart failure; Electric impedance; Hand strength; Cardiac rehabilitation

Reference

1. Okura Y, Ramadan MM, Ohno Y, Mitsuma W, Tanaka K, Ito M, et al. Impending epidemic: future projection of heart failure in Japan to the year 2055. Circ J. 2008; 72:489–91.
Article
2. Benjamin EJ, Muntner P, Alonso A, Bittencourt MS, Callaway CW, Carson AP, et al. Heart disease and stroke statistics-2019 update: a report from the American Heart Association. Circulation. 2019; 139:e56–528. Erratum in: Circulation 2020;141:e33.
3. Jones NR, Roalfe AK, Adoki I, Hobbs FDR, Taylor CJ. Survival of patients with chronic heart failure in the community: a systematic review and meta-analysis. Eur J Heart Fail. 2019; 21:1306–25.
Article
4. Vest AR, Chan M, Deswal A, Givertz MM, Lekavich C, Lennie T, et al. Nutrition, obesity, and cachexia in patients with heart failure: a consensus statement from the Heart Failure Society of America Scientific Statements Committee. J Card Fail. 2019; 25:380–400.
Article
5. Lukaski HC. Evolution of bioimpedance: a circuitous journey from estimation of physiological function to assessment of body composition and a return to clinical research. Eur J Clin Nutr. 2013; 67 Suppl 1:S2–9.
Article
6. Garlini LM, Alves FD, Ceretta LB, Perry IS, Souza GC, Clausell NO. Phase angle and mortality: a systematic review. Eur J Clin Nutr. 2019; 73:495–508.
Article
7. Alves FD, Souza GC, Clausell N, Biolo A. Prognostic role of phase angle in hospitalized patients with acute decompensated heart failure. Clin Nutr. 2016; 35:1530–4.
Article
8. Colín-Ramírez E, Castillo-Martínez L, Orea-Tejeda A, Vázquez-Durán M, Rodríguez AE, Keirns-Davis C. Bioelectrical impedance phase angle as a prognostic marker in chronic heart failure. Nutrition. 2012; 28:901–5.
Article
9. Norman K, Stobäus N, Pirlich M, Bosy-Westphal A. Bioelectrical phase angle and impedance vector analysis--clinical relevance and applicability of impedance parameters. Clin Nutr. 2012; 31:854–61.
10. Hajahmadi M, Shemshadi S, Khalilipur E, Amin A, Taghavi S, Maleki M, et al. Muscle wasting in young patients with dilated cardiomyopathy. J Cachexia Sarcopenia Muscle. 2017; 8:542–8.
Article
11. Okita K, Kinugawa S, Tsutsui H. Exercise intolerance in chronic heart failure--skeletal muscle dysfunction and potential therapies. Circ J. 2013; 77:293–300.
12. Fuentes-Abolafio IJ, Stubbs B, Pérez-Belmonte LM, Bernal-López MR, Gómez-Huelgas R, Cuesta-Vargas AI. Physical functional performance and prognosis in patients with heart failure: a systematic review and meta-analysis. BMC Cardiovasc Disord. 2020; 20:512.
Article
13. Attaway A, Bellar A, Dieye F, Wajda D, Welch N, Dasarathy S. Clinical impact of compound sarcopenia in hospitalized older adult patients with heart failure. J Am Geriatr Soc. 2021; 69:1815–25.
Article
14. Izawa KP, Watanabe S, Osada N, Kasahara Y, Yokoyama H, Hiraki K, et al. Handgrip strength as a predictor of prognosis in Japanese patients with congestive heart failure. Eur J Cardiovasc Prev Rehabil. 2009; 16:21–7.
Article
15. Fisher S, Smart NA, Pearson MJ. Resistance training in heart failure patients: a systematic review and metaanalysis. Heart Fail Rev. 2022; 27:1665–82.
Article
16. Dos Santos L, Cyrino ES, Antunes M, Santos DA, Sardinha LB. Changes in phase angle and body composition induced by resistance training in older women. Eur J Clin Nutr. 2016; 70:1408–13.
Article
17. Norman K, Wirth R, Neubauer M, Eckardt R, Stobäus N. The bioimpedance phase angle predicts low muscle strength, impaired quality of life, and increased mortality in old patients with cancer. J Am Med Dir Assoc. 2015; 16:173.e17–22.
Article
18. Dos Reis AS, Santos HO, Limirio LS, de Oliveira EP. Phase angle is associated with handgrip strength but not with sarcopenia in kidney transplantation patients. J Ren Nutr. 2019; 29:196–204.
Article
19. de Blasio F, Santaniello MG, de Blasio F, Mazzarella G, Bianco A, Lionetti L, et al. Raw BIA variables are predictors of muscle strength in patients with chronic obstructive pulmonary disease. Eur J Clin Nutr. 2017; 71:1336–40.
Article
20. Ho KK, Anderson KM, Kannel WB, Grossman W, Levy D. Survival after the onset of congestive heart failure in Framingham Heart Study subjects. Circulation. 1993; 88:107–15.
Article
21. Cohen J. Statistical power analysis for the behavioral sciences. 2nd ed. New York: Routledge;1988. p. 1–590.
22. Umehara T, Kaneguchi A, Kawakami W, Katayama N, Kito N. Association of muscle mass and quality with hand grip strength in elderly patients with heart failure. Heart Vessels. 2022; 37:1380–6.
Article
23. Baker PS, Bodner EV, Allman RM. Measuring lifespace mobility in community-dwelling older adults. J Am Geriatr Soc. 2003; 51:1610–4.
Article
24. Satake S, Shimada H, Yamada M, Kim H, Yoshida H, Gondo Y, et al. Prevalence of frailty among community-dwellers and outpatients in Japan as defined by the Japanese version of the Cardiovascular Health Study criteria. Geriatr Gerontol Int. 2017; 17:2629–34.
Article
25. Guralnik JM, Simonsick EM, Ferrucci L, Glynn RJ, Berkman LF, Blazer DG, et al. A short physical performance battery assessing lower extremity function: association with self-reported disability and prediction of mortality and nursing home admission. J Gerontol. 1994; 49:M85–94.
Article
26. Massari F, Mastropasqua F, Guida P, De Tommasi E, Rizzon B, Pontraldolfo G, et al. Whole-body bioelectrical impedance analysis in patients with chronic heart failure: reproducibility of the method and effects of body side. Ital Heart J. 2001; 2:594–8.
27. Bosy-Westphal A, Danielzik S, Dörhöfer RP, Later W, Wiese S, Müller MJ. Phase angle from bioelectrical impedance analysis: population reference values by age, sex, and body mass index. JPEN J Parenter Enteral Nutr. 2006; 30:309–16.
Article
28. Yamada M, Kimura Y, Ishiyama D, Nishio N, Otobe Y, Tanaka T, et al. Phase angle is a useful indicator for muscle function in older adults. J Nutr Health Aging. 2019; 23:251–5.
Article
29. Baumgartner RN, Chumlea WC, Roche AF. Bioelectric impedance phase angle and body composition. Am J Clin Nutr. 1988; 48:16–23.
30. Yamada Y, Schoeller DA, Nakamura E, Morimoto T, Kimura M, Oda S. Extracellular water may mask actual muscle atrophy during aging. J Gerontol A Biol Sci Med Sci. 2010; 65:510–6.
Article
31. Gheorghiade M, Follath F, Ponikowski P, Barsuk JH, Blair JE, Cleland JG, et al. Assessing and grading congestion in acute heart failure: a scientific statement from the acute heart failure committee of the heart failure association of the European Society of Cardiology and endorsed by the European Society of Intensive Care Medicine. Eur J Heart Fail. 2010; 12:423–33.
Article
32. Basile C, Della-Morte D, Cacciatore F, Gargiulo G, Galizia G, Roselli M, et al. Phase angle as bioelectrical marker to identify elderly patients at risk of sarcopenia. Exp Gerontol. 2014; 58:43–6.
Article
33. Miller MS, Vanburen P, Lewinter MM, Lecker SH, Selby DE, Palmer BM, et al. Mechanisms underlying skeletal muscle weakness in human heart failure: alterations in single fiber myosin protein content and function. Circ Heart Fail. 2009; 2:700–6.
34. Kinugasa Y, Miyagi M, Sota T, Yamada K, Ishisugi T, Hirai M, et al. Dynapenia and diaphragm muscle dysfunction in patients with heart failure. Eur J Prev Cardiol. 2018; 25:1785–6.
Article
35. von Haehling S, Ebner N, Dos Santos MR, Springer J, Anker SD. Muscle wasting and cachexia in heart failure: mechanisms and therapies. Nat Rev Cardiol. 2017; 14:323–41.
Article
36. Bertolini GN, de Alencar Silva BS, Dos Santos VR, de Anchieta Messias I, Ribeiro JPJ, Marini E, et al. Are bioelectrical parameters and functionality associated with postural control in the elderly? Clin Biomech (Bristol, Avon). 2021; 82:105258.
Article
37. Matias CN, Nunes CL, Francisco S, Tomeleri CM, Cyrino ES, Sardinha LB, et al. Phase angle predicts physical function in older adults. Arch Gerontol Geriatr. 2020; 90:104151.
Article
38. Houchen-Wolloff L, Daynes E, Watt A, Chaplin E, Gardiner N, Singh S. Which functional outcome measures can we use as a surrogate for exercise capacity during remote cardiopulmonary rehabilitation assessments? A rapid narrative review. ERJ Open Res. 2020; 6:00526–2020.
Article
39. Hong KH, Park KS. The influence of urine volume on body impedance measurement. Annu Int Conf IEEE Eng Med Biol Soc. 2008; 2008:2161–4.
Article
40. Caton JR, Molé PA, Adams WC, Heustis DS. Body composition analysis by bioelectrical impedance: effect of skin temperature. Med Sci Sports Exerc. 1988; 20:489–91.
Full Text Links
  • ARM
Actions
Cited
CITED
export Copy
Close
Share
  • Twitter
  • Facebook
Similar articles
Copyright © 2024 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: koreamed@kamje.or.kr