แรงบีบมือกับการทำนายสมรรถภาพการออกกำลังกายในสตรีที่มีภาวะอ้วน: การศึกษาแบบย้อนหลัง

Rungrudee  Pholboon; Maneepun  Laophosri; Wantipa  Pudonmaung; Supreeya  Rachashiha; Jittima Saengsuwan

Authors

Rungrudee Pholboon Physical Therapist, Physical therapy unit, Department of Rehabilitation Medicine, Srinagarind Hospital, Faculty of Medicine, Khon Kaen University
Maneepun Laophosri Physical Therapist, Physical therapy unit, Department of Rehabilitation Medicine, Srinagarind Hospital, Faculty of Medicine, Khon Kaen University
Wantipa Pudonmaung Physical Therapist, Physical therapy unit, Department of Rehabilitation Medicine, Srinagarind Hospital, Faculty of Medicine, Khon Kaen University
Supreeya Rachashiha Physical Therapist, Physical therapy unit, Department of Rehabilitation Medicine, Srinagarind Hospital, Faculty of Medicine, Khon Kaen University
Jittima Saengsuwan Department of Rehabilitation Medicine, Faculty of Medicine, Khon Kaen University

Keywords:

obesity, grip strength, relationship, 6-minute walk test, exercise capacity, ROC analysis, screening

Abstract

Background: Obesity is a critical global public health issue, particularly among women, affecting both physical and mental health. The 6-Minute Walk Test (6MWT) is the most commonly used assessments of exercise capacity. However, such testing may be difficult to perform in patients with obesity due to limitations related to safety concerns, as well as constraints in space and time. In contrast, handgrip strength (HGS) is a simple, rapid assessment using handgrip dynamometry that reflects overall muscle strength and endurance for long‑distance walking such as the 6MWT. This study aimed to investigate the relationship between handgrip strength and the 6MWT in women with obesity.

Methods: This retrospective study included 57 women with obesity referred to the Physical Therapy Unit, Srinagarind Hospital, Faculty of Medicine, Khon Kaen University. Handgrip strength was measured using a handgrip dynamometer, and exercise capacity was measured using the 6MWT. The correlation was analyzed using Spearman’s rank correlation. Receiver operating characteristic (ROC) analysis was performed to determine the ability of grip strength to identify reduced exercise capacity.

Results: Participants had a median age of 31 years (IQR = 18) and a median BMI of 38.3 kg/m² (IQR = 9.4). Mean handgrip strength was 24.1 kg (SD = 6.2), and the median 6MWT distance was 363 m (IQR = 59). Handgrip strength showed a significant positive correlation with the 6MWT (r_s = 0.59, p < 0.001). Receiver operating characteristic (ROC) analysis demonstrated that handgrip strength had good accuracy in identifying reduced exercise capacity (AUC [95% CI] = 0.75 (0.55 -0.96). The optimal cut-off value was 27 kg, yielding a sensitivity of 80% and a specificity of 69.2%.

Conclusions: Handgrip strength is significantly correlated with exercise capacity in women with obesity. It may serve as a viable clinical screening tool for identifying reduced exercise capacity in this population.

References

GBD 2021 Adult BMI Collaborators. Global, regional, and national prevalence of adult overweight and obesity, 1990-2021, with forecasts to 2050: a forecasting study for the Global Burden of Disease Study 2021. Lancet. 2025;405(10481):813-38.

Vichitkunakorn P, Bunyanukul W, Apiwan K, Tanasanchonnakul D, Sittisombut M. Prevalence of non-communicable disease risk factors and their association with economic status: findings from the 2021 health behaviour of population survey in Thailand. Glob Health Action. 2025;18(1):2485689.

Jitnarin N, Kosulwat V, Rojroongwasinkul N, Boonpraderm A, Haddock CK, Poston WS. Prevalence of overweight and obesity in Thai population: results of the National Thai Food Consumption Survey. Eat Weight Disord. 2011;16(4):e242-9.

Ovarian cancer and body size: individual participant meta-analysis including 25,157 women with ovarian cancer from 47 epidemiological studies. PLoS Med. 2012;9(4):e1001200.

Hart DA. Sex differences in musculoskeletal injury and disease risks across the lifespan: Are there unique subsets of females at higher risk than males for these conditions at distinct stages of the life cycle? Front Physiol. 2023;14:1127689.

Guglielmi V, Dalle Grave R, Leonetti F, Solini A. Female obesity: clinical and psychological assessment toward the best treatment. Front Endocrinol (Lausanne). 2024;15:1349794.

Martín-Ponce E, Hernández-Betancor I, González-Reimers E, Hernández-Luis R, Martínez-Riera A, Santolaria F. Prognostic value of physical function tests: hand grip strength and six-minute walking test in elderly hospitalized patients. Sci Rep. 2014;4:7530.

Hamdani R, Florencia Leona D. Relationship Between Handgrip Strength with the 6-Minute Walking Test Distance in Heart Failure Patients. INSOLOGI: Jurnal Sains dan Teknologi. 2023.

Zhang Q, Lu H, Pan S, Lin Y, Zhou K, Wang L. 6MWT Performance and its Correlations with VO₂ and Handgrip Strength in Home-Dwelling Mid-Aged and Older Chinese. Int J Environ Res Public Health. 2017;14(5):473.

Delbressine JM, Jensen D, Vaes AW, Li PZ, Bourbeau J, Tan WC, et al. Reference values for six-minute walk distance and six-minute walk work in Caucasian adults. Pulmonology. 2023;29(5):399-409.

Tomkinson GR, Lang JJ, Rubín L, McGrath R, Gower B, Boyle T, et al. International norms for adult handgrip strength: A systematic review of data on 2.4 million adults aged 20 to 100+ years from 69 countries and regions. J Sport Health Sci. 2025;14:101014.

Song JS, Kim H, Jung M. When and Why Do Sex Differences in Handgrip Strength Emerge? Age-Varying Effects of Testosterone From Childhood to Older Adulthood. Am J Hum Biol. 2025;37(10):e70155.

Hulley SB, Cummings SR, Browner WS, Grady D, Newman TB. Designing clinical research: an epidemiologic approach. 4th ed. ed. Philadelphia: Lippincott Williams & Wilkins; 2013.

Haam JH, Kim BT, Kim EM, Kwon H, Kang JH, Park JH, et al. Diagnosis of Obesity: 2022 Update of Clinical Practice Guidelines for Obesity by the Korean Society for the Study of Obesity. J Obes Metab Syndr. 2023;32(2):121-9.

สำนักวิทยาศาสตร์การกีฬา กรมพลศึกษา กระทรวงการท่องเที่ยวและกีฬา. แบบทดสอบและเกณฑ์มาตรฐานสมรรถภาพทางกายของประชาชน อายุ 19–59 ปี [อินเทอร์เน็ต]. กรุงเทพฯ: สำนักวิทยาศาสตร์การกีฬา กรมพลศึกษา; 2562 [เข้าถึงเมื่อ 24 ก.พ. 2569]. เข้าถึงได้จาก: https://www.dpe.go.th/page/manual/content/516UPy_RO98iBQ3ngNTACg%253d%253d

Laboratories ACoPSfCPF. ATS statement: guidelines for the six-minute walk test. Am J Respir Crit Care Med. 2002;166(1):111-7.

Zeren M, Karci M, Demir R, Gurses HN, Oktay V, Uzunhasan I, et al. Cut-off values of 6-min walk test and sit-to-stand test for determining symptom burden in atrial fibrillation. Ir J Med Sci. 2022;191(6):2587-95.

Maki N, Yanagihara T, Wijesinghe AI, Sugai K, Kawamura T, Saeki Y, et al. Preoperative Six-Minute Walking Distance as a Predictor of Postoperative Complications in Patients Undergoing Lobectomy for Non-Small-Cell Lung Cancer. Adv Respir Med. 2025;93(6):52.

Hajian-Tilaki K. The choice of methods in determining the optimal cut-off value for quantitative diagnostic test evaluation. Statistical Methods in Medical Research. 2018;27(8):2374-83.

Schober P, Boer C, Schwarte LA. Correlation Coefficients: Appropriate Use and Interpretation. Anesth Analg. 2018;126(5):1763-8.

Cruz-Jentoft AJ, Bahat G, Bauer J, Boirie Y, Bruyère O, Cederholm T, et al. Sarcopenia: revised European consensus on definition and diagnosis. Age Ageing. 2019;48(4):601.

Chen LK, Hsiao FY, Akishita M, Assantachai P, Lee WJ, Lim WS, et al. A focus shift from sarcopenia to muscle health in the Asian Working Group for Sarcopenia 2025 Consensus Update. Nat Aging. 2025;5(11):2164-75.

Bohannon RW. Hand-grip dynamometry predicts future outcomes in aging adults. J Geriatr Phys Ther. 2008;31(1):3-10.

de Sire A, Marotta N, Prestifilippo E, Calafiore D, Lippi L, Sconza C, et al. Influence of hand grip strength test and short physical performance battery on FRAX in post-menopausal women: a machine learning cross-sectional study. J Sports Med Phys Fitness. 2024;64(3):293-300.

Trajkov M, Cuk I, Eminovic F, Kljajic D, Dopsaj M. Relationship between hand grip strength and endurance and postural stability in active and sedentary older women. J Electromyogr Kinesiol. 2018;43:62-7.

Ari Wibowo R, Wahyuningsih A, Kusuma R, Pamungkasih W, Agustiningsih D. The association of six-minutes walking test (6MWT) with cardiovascular disease risk among older women with type 2 diabetes mellitus in a rural primary health care: a pilot observational study. Journal of Community Empowerment for Health. 2020;3:34.

Mahisanun T, Saengsuwan J. Validation of three functional tests against the 6-minute walk test in individuals with obesity. PeerJ. 2025;13:e19755.

Regan E, Middleton A, Stewart JC, Wilcox S, Pearson JL, Fritz S. The six-minute walk test as a fall risk screening tool in community programs for persons with stroke: a cross-sectional analysis. Top Stroke Rehabil. 2020;27(2):118-26.

Yakut Ozdemir H, Bozdemir Ozel C, Dural M, Yalvac HE, Al A, Murat S, et al. The 6-minute walk test and fall risk in patients with heart failure: A cross-sectional study. Heart Lung. 2024;64:80-5.

Aida K, Kamiya K, Hamazaki N, Nozaki K, Ichikawa T, Nakamura T, et al. Optimal cutoff values for physical function tests in elderly patients with heart failure. Sci Rep. 2022;12(1):6920.

Otadi K, Malmir K. Normative reference values for the six-minute walk test in older adults: A systematic review and meta-analysis. Arch Gerontol Geriatr. 2026;140:106026.