Clinical importance of simple muscular fitness tests to predict long-term health conditions: a systematic review and meta-analysis of 94 cohort studies

Objective To examine the predictive validity of field-based muscular strength tests in relation to incident long-term health conditions among adults. Design Systematic review and meta-analysis. Data sources PubMed, Web of Science, SPORTDiscus, Scopus, CINAHL, Epistemonikos and Google Scholar. Eligibility criteria Cohort studies examining the predictive value of validated and/or reliable field-based muscular strength tests in relation to long-term health conditions in adults aged ≥18 years. Results A total of 155 studies were included with 94 included in the meta-analysis. Adults with the highest (vs lowest) handgrip strength levels had a lower risk of multiple long-term health conditions (all p<0.05), including cardiovascular diseases (OR=0.73; 95% CI 0.67 to 0.80), type 2 diabetes mellitus (OR=0.79; 95% CI 0.68 to 0.91), musculoskeletal impairment (OR=0.65; 95% CI 0.56 to 0.76), disability (OR=0.57; 95% CI 0.47 to 0.70), anxiety (OR=0.79; 95% CI 0.63 to 0.99), depression (OR=0.70; 95% CI 0.63 to 0.78), cognitive decline (OR=0.57; 95% CI 0.44 to 0.75), dementia (OR=0.62; 95% CI 0.53 to 0.73) and Parkinson’s disease (OR=0.53; 95% CI 0.31 to 0.91). A 5 kg increase in handgrip strength was associated with a lower risk of developing most of these long-term health conditions. In turn, adults with the best (vs worst) performance on the 5-repetition chair-stand test had a lower risk of type 2 diabetes mellitus (OR=0.80; 95% CI 0.72 to 0.88), musculoskeletal impairment (OR=0.52; 95% CI 0.37 to 0.74), disability (OR=0.58; 95% CI 0.41 to 0.82), depression (OR=0.63; 95% CI 0.42 to 0.95), and dementia (OR=0.68; 95% CI 0.54 to 0.85). Every 1 s decrease was associated with 0.94 lower odds of musculoskeletal impairment. The overall quality of the evidence ranged from very low to moderate, indicating limited to moderate confidence in the results. Conclusions Our findings suggest increased handgrip strength and chair-stand test performance are associated with a lower risk of multiple long-term health conditions among adults. This research underscores the predictive value of simple field-based muscular strength tests which appear to be clinically useful for adults across different age groups and demographic profiles.