Validity of the German Version of the Continuous-Scale Physical Functional Performance 10 Test.

BACKGROUND: The Continuous-Scale Physical Functional Performance 10 Test (CS-PFP 10) quantitatively assesses physical functional performance in older adults who have a broad range of physical functional ability. This study assessed the validity and reliability of the CS-PFP 10 German version. METHODS: Forward-translations and backtranslations as well as cultural adaptions of the test were conducted. Participants were German-speaking Swiss community-dwelling adults aged 64 and older. Concurrent validity was assessed using Pearson correlation coefficients between CS-PFP 10 and gait velocity, Timed Up and Go Test, hand grip strength, SF-36 physical function domain, and Freiburger Physical Activity Questionnaire. Internal consistency was calculated by Cronbach's alpha. RESULTS: Backtranslation and cultural adaptions were accepted by the CS-PFP 10 developer. CS-PFP 10 total score and subscores (upper body strength, upper body flexibility, lower body strength, balance and coordination, and endurance) correlated significantly with all measures of physical function tested. Internal consistency was high (Cronbach's alpha 0.95-0.98). CONCLUSION: The CS-PFP 10 German version is valid and reliable for measuring physical functional performance in German-speaking Swiss community-dwelling older adults. Quantifying physical function is essential for clinical practice and research and provides meaningful insight into physical functional performance of older adults. This trial is registered with ClinicalTrials.gov NCT01539200.

Functional performance differences between the Genium and C-Leg prosthetic knees and intact knees.

Microprocessor prosthetic knees (MPKs) have advanced technologically, offering new features to decrease impairment and activity limitations for persons with transfemoral amputation (TFA). The Genium knee is functionally untested, and functional differences between it and intact knees are unknown. This study sought to determine whether Genium use improves functional performance compared with the C-Leg. A randomized experimental crossover design was used, with a cross-section of five nonamputee controls for comparison to normal. Twenty community-ambulating persons with TFA were trained and tested for accommodation with study components. All subjects (n = 25) were assessed using the Continuous-Scale Physical Functional Performance-10 (CS-PFP10) assessment. Subjects with TFA used both MPK systems. Genium use improved upper-body flexibility, balance, and endurance domain scores (7.0%-8.4%, p

CONCURRENT VALIDITY OF THE CONTINUOUS SCALE-PHYSICAL FUNCTIONAL PEFORMANCE-10 (CS-PFP-10) TEST IN TRANSFEMORAL AMPUTEES.

The Continuous Scale-Physical Functional Performance-10 (CS-PFP-10) test consists of 10 standardized daily living tasks that evaluate overall physical functional performance and performance in five individual functional domains: upper body strength (UBS), upper body flexibility (UBF), lower body strength (LBS), balance and coordination (BAL), and endurance (END). This study sought to determine the concurrent validity of the CS-PFP-10 test and its functional domains that involve the lower extremities (LBS, BAL, or END) in comparison to measures that have established validity for use in persons with transfemoral amputation (TFA). Ten TFA patients functioning at K3 or higher (Medicare Functional Classification Level) completed the study. Participants were assessed performing the CS-PFP-10, Amputee Mobility Predictor (AMP), 75 m self-selected walking speed (75 m SSWS) test, timed down stair walking (DN stair time), and the limits of stability (LOS) balance test. Concurrent validity was assessed using correlation analysis. The AMP, 75 m SSWS, LOS, and the DN stair time tests were strongly correlated (r = ± 0.76 to 0.86) with their paired CS-PFP-10 domain score (LBS, BAL, or END) and CS-PFP-10 total score. These findings indicate that the lower limb and balance domains of the CS-PFP-10 are valid measures to assess the physical functional performance of TFA patients.

Vitamin D status is associated with grip strength in centenarians.

Low serum concentrations of 25-hydroxyvitamin D (25(OH)D) have been associated with poor physical function in older adults, but few, if any, studies have examined this relationship in the very old. Therefore, the purpose of this study is to examine this relationship in the very old. Serum 25(OH)D concentrations were obtained from 194 centenarians and near centenarians (98 years and older). The associations between 25(OH)D concentrations and measures of physical function were evaluated with unadjusted and adjusted regression models. We found that 35% of centenarians had 25(OH)D concentrations less than 50 nmol/L. Adjusted mean grip strength was lower for centenarians with 25(OH)D concentrations less than 75 nmol/L than for centenarians with higher concentrations (P<0.05). However, there were no differences in the Georgia Centenarian Study (GCS) Composite Scale, a global measure of physical function, between those with higher and lower 25(OH)D concentrations. We conclude that low 25(OH)D concentrations are associated with poor grip strength, but not GCS Composite Scale, in the very old. Considering the high burden of poor physical function in older adults, understanding the relationship between vitamin D and different measures of physical function, including strength, becomes increasingly important.

Effects of testosterone and progressive resistance exercise in healthy, highly functioning older men with low-normal testosterone levels.

CONTEXT: Aging in men is associated with reduced testosterone (T) levels and physiological changes leading to frailty, but the benefits of T supplementation are inconclusive. OBJECTIVE: We studied the effects of T supplementation with and without progressive resistance training (PRT) on functional performance, strength, and body composition. DESIGN, SETTING, AND PARTICIPANTS: We recruited 167 generally healthy community-dwelling older men (66 ± 5 years) with low-normal baseline total T levels (200-350 ng/dL). INTERVENTION: Subjects were randomized to placebo or transdermal T gel [2 doses targeting either a lower (400-550 ng/dL) or higher (600-1000 ng/dL) T range] and to either PRT or no exercise for 12 months. MAIN OUTCOME MEASURE: The primary outcome was functional performance, whereas secondary outcomes were strength and body composition. RESULTS: A total of 143 men completed the study. At 12 months, total T was 528 ± 287 ng/dL in subjects receiving any T and 287 ± 65 ng/dL in the placebo group. In the PRT group, function and strength were not different between T- and placebo-treated subjects, despite greater improvements in fat mass (P = .04) and fat-free mass (P = .01) with T. In the non-PRT group, T did not improve function but improved fat mass (P = .005), fat-free mass (P = .03), and upper body strength (P = .03) compared with placebo. There were fewer cardiovascular events in the T-treated groups compared with placebo. CONCLUSIONS: T supplementation was well tolerated and improved body composition but had no effect on functional performance. T supplementation improved upper body strength only in nonexercisers compared with placebo.

Exercise efficiency is reduced by mitochondrial uncoupling in the elderly.

A reduction in exercise efficiency accompanies ageing in humans. Here we evaluated the impact of changes in the contractile-coupling and mitochondrial-coupling efficiencies on the reduction in exercise efficiency in the elderly. Nine adult (mean, 38.8 years old) and 40 elderly subjects (mean, 68.8 years old) performed a cycle ergometer test to measure O2 uptake and leg power output up to the aerobic limit ( ). Reduced leg power output per unit O2 uptake was reflected in a drop in delta efficiency (εD) from 0.27 ± 0.01 (mean ± SEM) in adults to 0.22 ± 0.01 in the elderly group. Similar declines with age were apparent for both the leg power output at and the ATP generation capacity (ATPmax) determined in vivo using (31)P magnetic resonance spectroscopy. These similar declines resulted in unchanged contractile-coupling efficiency values (εC) in the adult (0.50 ± 0.05) versus the elderly group (0.58 ± 0.04) and agreed with independent measures of muscle contractile-coupling efficiency in human quadriceps (0.5). The mitochondrial-coupling efficiency calculated from the ratio of delta to contractile-coupling efficiencies in the adults (εD/εC = 0.58 ± 0.08) corresponded to values for well-coupled mitochondria (0.6); however, εD/εC was significantly lower in the elderly subjects (0.44 ± 0.03). Conversion of ATPmax per mitochondrial volume (ATPmax/Vv[mt,f]) reported in these groups into thermodynamic units confirmed this drop in mitochondrial-coupling efficiency from 0.57 ± 0.08 in adults to 0.41 ± 0.03 in elderly subjects. Thus, two independent methods revealed that reduced mitochondrial-coupling efficiency was a key part of the drop in exercise efficiency in these elderly subjects and may be an important part of the loss of exercise performance with age.

Elevated energy coupling and aerobic capacity improves exercise performance in endurance-trained elderly subjects.

Increased maximal oxygen uptake (V(O(2)max)), mitochondrial capacity and energy coupling efficiency are reported after endurance training (ET) in adult subjects. Here we test whether leg exercise performance (power output of the legs, P(max), at V(O(2)max)) reflects these improvements with ET in the elderly. Fifteen male and female subjects were endurance trained for a 6 month programme, with 13 subjects (69.5 ± 1.2 years old, range 65-80 years old; n = 7 males; n = 6 females) completing the study. This training significantly improved P(max) (Δ17%; P = 0.003), V(O(2)max) (Δ5.4%; P = 0.021) and the increment in oxygen uptake (V(O(2))) above resting (ΔV(O(2)m-r) = V(O(2)max) - V(O(2)rest; Δ9%; P < 0.02). In addition, evidence of improved energy coupling came from elevated leg power output per unit V(O(2))at the aerobic capacity [Δ(P(max)/ΔV(O(2)m-r)); P = 0.02] and during submaximal exercise in the ramp test as measured by delta efficiency (ΔP(ex)/ΔV(O(2)); P = 0.04). No change was found in blood lactate, muscle glycolysis or fibre type. The rise in P(max) paralleled the improvement in muscle oxidative phosphorylation capacity (ATP(max)) in these subjects. In addition, the greater exercise energy coupling [Δ(P(max)/ΔV(O(2)m-r)) and delta efficiency] was accompanied by increased mitochondrial energy coupling as measured by elevated ATP production per unit mitochondrial content in these subjects. These results suggest that leg exercise performance benefits from elevations in energy coupling and oxidative phosphorylation capacity at both the whole-body and muscle levels that accompany endurance training in the elderly.

A combined aerobic and resistance exercise program improves physical functional performance in patients with heart failure: a pilot study.

BACKGROUND: Recent guidelines for exercise in patients with heart failure (HF) recommended aerobic and resistance exercise as being safe and effective; however, the clinical and functional significance of these combined training modalities has not been established. In this pilot study, combined aerobic and resistance training was hypothesized to improve physical function, muscle strength, and health-related quality of life (HRQOL) compared with an attention control wait list (ACWL). METHODS: The 10-item Continuous Scale Physical Functional Performance Test (CS-PFP10), which simulates common household chores; muscle strength (handgrip and knee extension); and HRQOL (Kansas City Cardiomyopathy Questionnaire) were evaluated at baseline (T1) and at 12 weeks (T2). The home-based moderate-intensity walking and resistance training program was performed 5 days a week. RESULTS: Twenty-four New York Heart Association class II to III HF patients (mean [SD] age, 60 [10] years; mean [SD] left ventricular ejection fraction, 25% [9%]) were randomized to a combined aerobic and resistance exercise program or to an ACWL group. Of the total group, 58% were New York Heart Association class III HF patients, 50% were white, and 50% were female. The CS-PFP10 total scores were significantly increased in the exercise group, from 45 (18) to 56 (16). The Kansas City Cardiomyopathy Questionnaire overall summary score was significantly improved (P < .001) at T2 in the exercise intervention group compared with the ACWL group. CONCLUSIONS: Participants provided the home-based, combined aerobic and resistance exercise program had significantly improved physical function, muscle strength, symptom severity, and HRQOL compared with the ACWL group. The findings of this study must be interpreted cautiously owing to the limitations of a small sample, data collection from a single center, and differences between control and interventions groups at baseline. A combined aerobic and resistance exercise approach may improve physical function in stable HF patients, but further study in a larger, more diverse population is recommended. However, in this study, the CS-PFP10 instrument demonstrated its ability to identify functional health status in HF patients and thus warrants further testing in a larger sample for possible use in clinical practice.

Combined aerobic and resistance exercise program improves task performance in patients with heart failure.

OBJECTIVES: To assess the effects of a home-based aerobic and resistance training program on the physical function of adults with New York Heart Association (NYHA) class II and III patients and systolic heart failure (HF). DESIGN: Randomized controlled trial. SETTING: Home based. PARTICIPANTS: Stable patients (N=24; mean age, 60 ± 10 y; left ventricular ejection fraction, 25% ± 9%; 50% white; 50% women) with New York Heart Association (NYHA) classes II and III (NYHA class III, 58%) systolic heart failure (HF). INTERVENTION: A 12-week progressive home-based program of moderate-intensity aerobic and resistance exercise. Attention control wait list participants performed light stretching and flexibility exercises. MAIN OUTCOME MEASURES: A 10-item performance-based physical function measure, the Continuous Scale Physical Functional Performance test (CS-PFP10), was the major outcome variable and included specific physical activities measured in time to complete a task, weight carried during a task, and distance walked. Other measures included muscle strength, HRQOL (Minnesota Living With Heart Failure Questionnaire, Epworth Sleepiness Scale), functional capacity (Duke Activity Status Index), and disease severity (brain natriuretic peptide) levels. RESULTS: After the exercise intervention, 9 of 10 specific task activities were performed more rapidly, with increased weight carried by exercise participants compared with the attention control wait list group. Exercise participants also showed significant improvements in CS-PFP10 total score (P<.025), upper and lower muscle strength, and HRQOL (P<.001) compared with the attention control wait list group. Adherence rates were 83% and 99% for the aerobic and resistance training, respectively. CONCLUSIONS: Patients with stable HF who participate in a moderate-intensity combined aerobic and resistance exercise program may improve performance of routine physical activities of daily living by using a home-based exercise approach. Performance-based measures such as the CS-PFP10 may provide additional insights into physical function in patients with HF that more commonly used exercise tests may not identify. Early detection of subtle changes that may signal declining physical function that are amenable to intervention potentially may slow further loss of function in this patient population.

Safety and efficacy of supervised strength training adopted in pregnancy.

OBJECTIVE: Describe safety and efficacy of a supervised, low-to-moderate intensity strength training program adopted during pregnancy among women at increased risk for back pain. METHODS: 32 women adopted strength training twice per week for 12 weeks. Data on musculoskeletal injuries, symptoms, blood pressure, and the absolute external load used for 5 of 6 exercises were obtained during each session. A submaximal lumbar extension endurance exercise test was performed at weeks 5, 10, and 13. RESULTS: The mean (± SD) exercise session attendance rate was 80.5% (± 11.3%). No musculoskeletal injuries occurred. Potentially adverse symptoms (eg, dizziness) were infrequent (2.1% of sessions). Repeated-measures ANOVA showed large increases in the external load across 12 weeks (all P values < .001) and the percentage increases in external load from weeks 1 to 12 were 36% for leg press, 39% for leg curl, 39% for lat pull down, 41% for lumbar extension and 56% for leg extension. Training was associated with a 14% increase in lumbar endurance. Blood pressure was unchanged following acute exercise sessions and after 12 weeks of exercise training. CONCLUSION: The adoption of a supervised, low-to-moderate intensity strength training program during pregnancy can be safe and efficacious for pregnant women.

Living environment and mobility of older adults.

BACKGROUND: Older adults often elect to move into smaller living environments. Smaller living space and the addition of services provided by a retirement community (RC) may make living easier for the individual, but it may also reduce the amount of daily physical activity and ultimately reduce functional ability. OBJECTIVE: With home size as an independent variable, the primary purpose of this study was to evaluate daily physical activity and physical function of community dwellers (CD; n = 31) as compared to residents of an RC (n = 30). METHODS: In this cross-sectional study design, assessments included: the Continuous Scale Physical Functional Performance - 10 test, with a possible range of 0-100, higher scores reflecting better function; Step Activity Monitor (StepWatch 3.1); a physical activity questionnaire, the area of the home (in square meters). Groups were compared by one-way ANOVA. A general linear regression model was used to predict the number of steps per day at home. The level of significance was p < 0.05. RESULTS: Of the 61 volunteers (mean age: 79 ± 6.3 years; range: 65-94 years), the RC living space (68 ± 37.7 m(2)) was 62% smaller than the CD living space (182.8 ± 77.9 m(2); p = 0.001). After correcting for age, the RC took fewer total steps per day excluding exercise (p = 0.03) and had lower function (p = 0.005) than the CD. CONCLUSION: On average, RC residents take 3,000 steps less per day and have approximately 60% of the living space of a CD. Home size and physical function were primary predictors of the number of steps taken at home, as found using a general linear regression analysis.

Assessing physical performance in centenarians: norms and an extended scale from the georgia centenarian study.

Centenarians display a broad variation in physical abilities, from independence to bed-bound immobility. This range of abilities makes it difficult to evaluate functioning using a single instrument. Using data from a population-based sample of 244 centenarians (M(Age) = 100.57 years, 84.8% women, 62.7% institutionalized, and 21.3% African American) and 80 octogenarians (M(Age) = 84.32 years, 66.3% women, 16.3% institutionalized, and 17.5% African American) we (1) provide norms on the Short Physical Performance Battery and (2) extend the range of this scale using performance on additional tasks and item response theory (IRT) models, reporting information on concurrent and predictive validity of this approach. Using the original SPPB scoring criteria, 73.0% of centenarian men and 86.0% of centenarian women are identified as severely impaired by the scale's original classification scheme. Results suggest that conventional norms for older adults need substantial revision for centenarian populations and that item response theory methods can be helpful to address floor and ceiling effects found with any single measure.

An evidence-based exercise program implemented in congregate-meal sites.

BACKGROUND: This study examined the feasibility of implementing the EnhanceFitness Program (formerly Lifetime Fitness Program), an evidence-based exercise program, at congregate-meal sites that generally serve low-income older adults. METHODS: A 12-week aerobic and strength training exercise program was held at senior centers 3 times a week. RESULTS: The mean age of the 31 participants was 73.5 years+/-6.7 years (60-86). Participants' compliance with attending the exercise class was 74%. Paired t tests were used to evaluate change after the intervention. Three out of six components of the Senior Fitness Test increased significantly after the exercise intervention (P<.003). Three out of the eight self-reported health concepts of the SF-36 demonstrated significant improvement after the exercise intervention (P<.003). CONCLUSION: These data indicate that an evidence-based exercise program can be successfully implemented in this population.

Use of the continuous scale physical functional performance test in stroke survivors.

OBJECTIVE: To (1) determine the feasibility of the continuous scale physical functional performance 10-item test (CS-PFP10) for the measurement of physical function in stroke survivors, (2) characterize physical functional performance of stroke survivors and their matched controls, and (3) explore the associations among physical functional performance, ambulatory activity, and peak oxygen uptake (VO2peak). DESIGN: Case control. SETTING: University research setting. PARTICIPANTS: Ten participants with stroke and 10 healthy controls matched for age, sex, and physical activity. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: The CS-PFP10 test was used to measure functional ability. The test requires performance of 10 serial tasks that range from low to high difficulty. The step activity monitor was used to measure absolute ambulatory activity and was reported as the average number of steps a day over a 4-day period. VO2peak was determined using a metabolic cart and a recumbent cycle ergometer. RESULTS: Stroke survivors scored lower than healthy controls on all individual tasks, domains, and the total score on the CS-PFP10. Higher VO2peak was associated with higher total scores on the CS-PFP10 in both stroke survivors and controls. In stroke survivors, lower levels of impairment (as indicated by the Chedoke-McMaster stroke assessment) were associated with higher total CS-PFP10 scores. CONCLUSIONS: The CS-PFP10 is a measure of physical performance that is feasible to use with ambulatory participants with stroke. Future investigations with people with stroke should explore the ability of the CS-PFP10 to provide meaningful information about change in CS-PFP10 subscales with interventions that target items on the subscales, such as balance or upper extremity strength.

Aerobic reserve and physical functional performance in older adults.

BACKGROUND: older adults can be limited in their performance of daily tasks due to an inadequate aerobic capacity. Aerobic capacity below minimum physiological thresholds required to maintain independence leaves older adults with little, or no, aerobic reserve. OBJECTIVE: the aim of this study was to measure functional performance and aerobic reserve in older adults during the serial performance of daily tasks. SUBJECTS: twenty-nine (n = 29) men and women (n = 23 females) 70-92 years of age participated in this study. METHODS: performance based physical function was assessed using the Continuous-Scale Physical Functional Performance test (CS-PFP). A Cosmed K4b(2) portable metabolic system was used to measure VO(2PEAK) and oxygen uptake during the serial performance of a battery of daily tasks (VO(2PFP)). Aerobic reserve was calculated as the difference between VO(2PEAK) and VO(2PFP). RESULTS: the correlation coefficient between aerobic reserve and functional performance was r = 0.50(P = 0.006). Participants utilized 32.2 +/- 8.1%, 42.7 +/- 10.8%, and 50.3 +/- 12.3% of VO(2PEAK) for the low, moderate, and high workloads of the CS-PFP, respectively. CONCLUSIONS: light housework and carrying groceries require 40 to 50% of peak oxygen consumption. This information can be used by clinicians and health professionals working with older adults as a guide to how much aerobic fitness is needed to perform ADLs and maintain independence. These can then be used as guides for assessment and for setting training goals in older adults.

Continuous scale physical functional performance test: appropriateness for middle-aged adults with and without Parkinson's disease.

PURPOSE: Functional measures are needed that are applicable to middle-aged adults with neurological disorders who are on the threshold of disability. One potential measure is the Continuous Scale Physical Functional Performance Test (CS-PFP), which has been normalized and validated to older adults but performance is unknown for adults younger than the age of 65 years with and without neurological disorders. The purposes of this investigation were (1) to compare scores on the CS-PFP of nondisabled adults in three age groups from 35 to 64 years with two groups of individuals older than the age of 65; (2) to determine whether there is a ceiling effect for nondisabled middle-aged adults; and (3) to determine whether performance of individuals in early stages of Parkinson's disease (PD) age 45 to 64 years differ significantly from performance of similarly aged nondisabled adults. METHODS: Data were obtained from three samples: (1) 37 adults with PD (45-54 and 55-64 years; 57% female), (2) 70 nondisabled adults (35-44, 45-54, and 55-64 years; 69% female); (3) 72 nondisabled older adults (65-74 and 75-85 years; 79% female). The CS-PFP was administered in a single test session for each subject. Analysis of variance was performed for group differences with adjustment of sex as a covariate followed by a Student-Newman-Keuls post hoc analysis. RESULTS: For nondisabled individuals, the CS-PFP total and domain scores were significantly lower in the oldest group (75-85 years) compared to all other age groups and significantly higher in the younger two groups (35-44 and 45-54 years) compared to the older groups. There was no ceiling effect for any domain score or total score for the adults younger than 65 years. For individuals with PD, both age groups had significantly lower scores on the CS-PFP than did the nondisabled counterparts. CONCLUSIONS: Results from the nondisabled middle-aged individuals provide comparison data to be used clinically or in investigations of middle-aged adults with neurological dysfunction. Comparison of middle-aged individuals with PD to middle-aged nondisabled adults illustrates the true extent of functional difficulty experienced by individuals with PD and demonstrates the importance of using age appropriate comparison data. The CS-PFP is particularly applicable to middle-aged adults with compromised functional performance for their age but is too high to be effectively quantified with other assessment measures.

Age-related deterioration in flexibility is associated with health-related quality of life in nonagenarians.

BACKGROUND AND PURPOSE: Studies indicate that age is associated with deterioration in physical function and a concomitant decrease in health-related quality of life (HRQL). The contribution of physical function to HRQL in nonagenarians (ages 90-99) is unknown. The purposes of this study were to examine age-related changes in physical function and HRQL among community-dwelling nonagenarians and to determine the relationship between their physical function and HRQL. METHODS: Seventy-four community-dwelling nonagenarians participated. The Continuous Scale Physical Function Performance Test-10 (CS-PFP10) was used to measure their physical function and the Short Form (SF)-36 was used to measure their HRQL. Pearson correlations were used to assess associations among age, physical function, and HRQL scores. RESULTS: Age was inversely associated with the upper body flexibility (r = -.365, p = .001) subscale of the CS-PFP10, but not significantly associated with any other physical function or HRQL score. Significant associations between physical function and HRQL were limited to those between upper body flexibility and the physical function subscale (r = .424, p < .001) and physical function component summary score (r = .376, p = .001) of the SF-36. CONCLUSION: These data suggest that upper body flexibility continues to decline during the 10th decade of life and has implications for influence on aspects of HRQL in this segment of the population.

A comparison of physical functional performance and strength in women with fibromyalgia, age- and weight-matched controls, and older women who are healthy.

BACKGROUND AND PURPOSE: The purpose of this study was to compare functionality and strength among women with fibromyalgia (FM), women without FM, and older women. SUBJECTS: Twenty-nine women with FM (age [X+/-SD]=46+/-7 years), 12 age- and weight-matched women without FM (age=44+/-8 years), and 38 older women who were healthy (age=71+/-7 years) participated. METHODS: The Continuous Scale-Physical Functional Performance Test (CS-PFP) was used to assess functionality. Isokinetic leg strength was measured at 60 degrees/s, and handgrip strength was measured using a handgrip dynamometer. RESULTS: The women without FM had significantly higher functionality scores compared with women with FM and older women. There were no differences in functionality between women with FM and older women. Strength measures for the leg were higher in women without FM compared with women with FM and older women, and both women with and without FM had higher grip strengths compared with older women. DISCUSSION AND CONCLUSION: This study demonstrated that women with FM and older women who are healthy have similar lower-body strength and functionality, potentially enhancing the risk for premature age-associated disability.