Toe Grip Strength Shows Stronger Associations with Falls than Knee Extension or Hand Grip in Older Adults: A 1-year Prospective Cohort Study

Abstract

Objectives: This study examined associations of toe grip strength (TGS) with fall occurrence and the number of falls in community-dwelling older adults and evaluated knee extension strength (KES) and hand grip strength (HGS) as established indicators.

Methods: Adults aged 65–94 years (n=208) at 2018 municipal health checkups were enrolled. TGS, KES, and HGS were measured with quantitative devices and normalized to body weight (%BW). Prior-year falls were recorded at baseline, and fall occurrence and the number of falls over the subsequent year were collected at the next annual checkup. Associations were estimated with multivariable logistic regression for fall occurrence and negative binomial regression for the number of falls, adjusted for age, sex, prior-year fall history, cardiovascular disease or stroke, physical activity, and serum albumin. Nonlinearity was assessed with restricted cubic splines.

Results: Higher TGS was associated with lower odds of fall occurrence [odds ratio (OR) 0.94, 95% confidence interval (CI) 0.89–0.99, P = 0.015] and fewer falls [risk ratio (RR) 0.95, 95% CI 0.91–0.99, P = 0.015]. KES was weakly associated with falls (OR 0.99, 95% CI 0.98–1.00, P = 0.041; RR 0.99, 95% CI 0.98–1.00, P = 0.042), whereas HGS showed no association. Splines indicated nonlinearity: TGS odds were flat around 17–27 %BW and rose below ~17 %BW; KES odds increased below ~75 %BW; HGS was flat around 45–55 %BW.

Conclusions: TGS was associated with fall occurrence and the number of falls, whereas KES showed weak associations and HGS showed no association, indicating that the TGS measurement may be useful for risk assessment.