Handgrip Strength in People With Chronic Obstructive Pulmonary Disease: A Systematic Review and Meta-Analysis.

OBJECTIVE The purpose of this study was to systematically review the association between handgrip strength (HGS) and mortality, morbidity, and health-related quality of life (HRQL) in individuals with chronic obstructive pulmonary disease (COPD). METHODS The following databases were used: CENTRAL, CINAHL, EMBASE, MEDLINE Ovid, SPORTDiscus, and PsycINFO. Studies published between 2000 and 2020 in English, Portuguese, or French that examined the association of HGS with mortality, morbidity and HRQL in individuals with stable COPD. Two authors independently extracted data and assessed the quality of evidence using the GRADE framework. The studies effects were pooled using random effects meta-analysis models after assessing heterogeneity. The search generated 710 studies and 18 were included in the review. Studies evaluated a total of 12,046 individuals with stable COPD (mean percent of the predicted forced expiratory volume in one second = 34-80) using over 10 diverse protocols for HGS measurement. Statistically significant, small and negative relationships were found between HGS and mortality (r = -0.03; 95% CI = -0.05 to -0.02). Independently of the outcome measure used to assess morbidity, the estimate of the overall relationship was small to moderate and negative: Body mass index, airflow Obstruction, Dyspnea, and Exercise index Updated (BODEu) (r = -0.42; 95% CI = -0.61 to -0.03); exacerbations (r = -0.02; 95% CI = -0.04 to -0.00); and hospitalizations (r = -0.69; 95% CI = -1.70 to 0.32). Similarly, for HRQL, independently of the outcome measure, the estimate of the overall relationship was small to fair and negative: COPD Assessment Test (weighted r = -0.22; 95% CI = -0.32 to -0.12); CRQ domains (-0.24 < r < -0.14); EuroQol Five-Dimension Questionnaire (EQ-5D) (utility score) (r = -0.17; 95% CI = -0.26 to -0.07); EQ-5D domains (-0.32 < r < -0.06); and St George Respiratory Questionnaire total (r = -0.26; 95% CI = -0.33 to -0.17). The quality of the evidence ranged from low to very low across outcomes. CONCLUSIONS Although heterogeneity was present among HGS measurement protocols, small to moderate associations were found, indicating that those with lower HGS have increased likelihood of death, a higher risk of increased COPD morbidity (as assessed with BODE indexes), and poorer HRQL.