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Article(id=1324077642839892106, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1324077560820282023, articleNumber=null, orderNo=null, doi=10.20043/j.cnki.MPM.202512076, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1764777600000, receivedDateStr=2025-12-04, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1793614310226, onlineDateStr=2026-11-02, pubDate=1774368000000, pubDateStr=2026-03-25, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1793614310226, onlineIssueDateStr=2026-11-02, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1793614310226, creator=13701087609, updateTime=1793614310226, updator=13701087609, issue=Issue{id=1324077560820282023, tenantId=1146029695717560320, journalId=1227665162245664772, year='2026', volume='53', issue='6', pageStart='961', pageEnd='1152', issueExtLink='null', onlineDate='null', pubDate='1774368000000', pubDateStr='2026-03-25', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=0, createTime=1793614290671, creator='13701087609', updateTime=1793614391469, updator='13701087609', preIssue=null, nextIssue=null, articleTotal=null, ext={EN=IssueExt(id=1324077983656444429, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1324077560820282023, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1324077983660638734, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1324077560820282023, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null, downloadFileDto=null}, startPage=973, endPage=980, ext={EN=ArticleExt(id=1324077644597305483, articleId=1324077642839892106, tenantId=1146029695717560320, journalId=1227665162245664772, language=EN, title=Association of handgrip strength and its changes with activities of daily living decline among middle-aged and older adults in China: a longitudinal study based on the CHARLS, columnId=1228016567443718970, journalTitle=Modern Preventive Medicine, columnName=Epidemiology and Statistical Methods Advances, runingTitle=null, highlight=null, articleAbstract=
Objective

To investigate the association between handgrip strength (HGS), its transitions, and the decline of activities of daily living (ADL) among middle-aged and older adults in China.

Methods

This study utilized data from waves 1 to 5 (2011 to 2020) of the China Health and Retirement Longitudinal Study (CHARLS). According to the Asian Work Group for Sarcopenia 2019 consensus, low HGS was defined as <28 kg for males and <18 kg for females. Based on the changes in HGS status from baseline to the second survey, participants were classified into four groups: stable normal HGS, normal HGS to low HGS, low HGS to normal HGS, and stable low HGS. ADL disability was measured by the number of daily activities with difficulty, with higher scores indicating poorer functional ability. Linear mixed-effect models were employed to investigate the association of handgrip strength and its transition patterns with ADL decline.

Results

Individuals with low HGS exhibited a higher level of ADL disability (β=0.607, 95% CI: 0.523-0.690, P<0.001) and a faster progression of ADL disability (β=0.085,95% CI: 0.068-0.101, P<0.001) compared to those with normal HGS. Compared with individuals with stable normal HGS, those with stable low HGS (β=0.153, 95% CI: 0.120-0.185, P<0.001) experienced the most rapid progression of ADL disability, followed by those transitioning from normal HGS to low HGS (β=0.081, 95% CI: 0.059-0.103, P<0.001).

Conclusion

Lower HGS is associated with accelerated ADL disability progression. Dynamic changes in handgrip strength also provide significant prognostic value for assessing the risk of ADL decline. Regular monitoring of handgrip strength and its changes may aid in the prevention and delay of ADL decline.

, authors=Lin-yang SONG1, Jing QI1, Zhu-jun CHONG1, Pei-yuan QIU1, Yang WAN2, authorsList=Lin-yang SONG, Jing QI, Zhu-jun CHONG, Pei-yuan QIU, Yang WAN, authorCompany=null, correspAuthors=Yang WAN, authorNote=null, correspAuthorsNote=null, copyrightStatement=null, copyrightOwner=null, extLink=null, articleAbsUrl=null, sourceXml=null, magXml=null, pdfUrl=null, pdf=null, pdfFileSize=null, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=null, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=null, mapNumber=null, fund=null), CN=ArticleExt(id=1324077645679435922, articleId=1324077642839892106, tenantId=1146029695717560320, journalId=1227665162245664772, language=CN, title=握力及其动态变化与中国中老年人日常生活活动能力衰退的关系：一项基于CHARLS的纵向研究, columnId=1228016567632462653, journalTitle=现代预防医学, columnName=流行病与统计方法, runingTitle=null, highlight=null, articleAbstract=
目的

探究中国中老年人握力及其变化与日常生活活动能力（activities of daily living, ADL）衰退的关联。

方法

本研究使用了中国健康与养老追踪调查2011—2020年的5次调查数据。依据亚洲肌肉减少症工作组共识，男性握力低于28 kg和女性握力低于18 kg定义为低握力。根据基线到第二次调查期间握力的变化，参与者被分为四组：握力持续正常，正常握力转为低握力，低握力转为正常握力和握力持续低。ADL评分为个体在完成日常活动时存在困难的项目数量，分数越高代表能力越差。采用线性混合效应模型分析握力及其变化模式与ADL衰退的关联。

结果

相较于正常握力者，低握力者基线ADL得分更高（β=0.607, 95% CI: 0.523~0.690, P<0.001），并且随访期间ADL得分增长更快（β = 0.085, 95% CI: 0.068~0.101, P<0.001）。与握力持续正常者相比，持续保持低握力者ADL得分增长最快（β=0.153, 95% CI: 0.120~0.185, P<0.001），其次为从正常握力转为低握力者（β=0.081, 95% CI: 0.059~0.103, P<0.001）。

结论

较低的握力与ADL加速衰退有关。握力的动态变化对ADL衰退风险评估也具有重要价值。定期监测握力及其变化有助于预防和延缓ADL衰退。

, authors=宋林阳1, 祁婧1, 重竺君1, 邱培媛1, 万洋2, authorsList=宋林阳, 祁婧, 重竺君, 邱培媛, 万洋, authorCompany=null, correspAuthors=万洋, authorNote=

宋林阳（2001—），男，硕士在读，研究方向：卫生统计方法与应用

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万洋，E-mail:
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JAMA Netw Open, 2021, 4(9): e2125577., articleTitle=Spousal concordance in the development of functional limitations among married adults in China, refAbstract=null)], funds=[Fund(id=1324077651777953993, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324077642839892106, awardId=72174133, language=CN, fundingSource=国家自然科学基金(72174133), fundOrder=null, country=null)], companyList=[AuthorCompany(id=1324077645973037203, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324077642839892106, xref=1., ext=[AuthorCompanyExt(id=1324077645981425812, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324077642839892106, companyId=1324077645973037203, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=Department of Epidemiology and Health Statistics, West China School of Public Health/West China Fourth Hospital, Sichuan University, Chengdu, Sichuan 610041, China), AuthorCompanyExt(id=1324077645989814421, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324077642839892106, companyId=1324077645973037203, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=1.四川大学华西公共卫生学院/华西第四医院 流行病与卫生统计学系，四川 成都 610041)]), AuthorCompany(id=1324077646157586582, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324077642839892106, xref=2., ext=[AuthorCompanyExt(id=1324077646170169495, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324077642839892106, companyId=1324077646157586582, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=2.四川大学华西公共卫生学院/华西第四医院 神经内科)])], figs=[ArticleFig(id=1324077650117009593, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324077642839892106, language=EN, label=Fig.1, caption=Selection process of the study population, figureFileSmall=JwPSkZmW5P2r/MEoeKPQvQ==, figureFileBig=cVIxf12TyuOVUsOIwdujaw==, tableContent=null), ArticleFig(id=1324077650192507066, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324077642839892106, language=CN, label=图1, caption=研究对象选取流程, figureFileSmall=JwPSkZmW5P2r/MEoeKPQvQ==, figureFileBig=cVIxf12TyuOVUsOIwdujaw==, tableContent=null), ArticleFig(id=1324077650431582395, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324077642839892106, language=EN, label=Fig.2, caption=ADL score trajectories by handgrip strength status, figureFileSmall=GPqybXnmV3Ckwr3jOn17aw==, figureFileBig=FuZcUhYemnHNRbYjxD7RhA==, tableContent=null), ArticleFig(id=1324077650519662780, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324077642839892106, language=CN, label=图2, caption=不同握力状态参与者的ADL得分变化轨迹, figureFileSmall=GPqybXnmV3Ckwr3jOn17aw==, figureFileBig=FuZcUhYemnHNRbYjxD7RhA==, tableContent=null), ArticleFig(id=1324077650603548861, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324077642839892106, language=EN, label=Fig.3, caption=ADL score trajectories by transition in handgrip strength status, figureFileSmall=7eM5AqfJxweDRsvaOe1ITQ==, figureFileBig=wmmLGsZtDXpCKZzBwepT+A==, tableContent=null), ArticleFig(id=1324077650691629246, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324077642839892106, language=CN, label=图3, caption=不同握力状态转变组参与者的ADL得分变化轨迹, figureFileSmall=7eM5AqfJxweDRsvaOe1ITQ==, figureFileBig=wmmLGsZtDXpCKZzBwepT+A==, tableContent=null), ArticleFig(id=1324077650834235583, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324077642839892106, language=EN, label=Table 1, caption=

Baseline characteristics of study population

, figureFileSmall=null, figureFileBig=null, tableContent=
特征总体正常握力低握力t/χ2值P值
年龄（岁）58.89±9.3057.98±8.7867.04±9.84-30.951<0.001
性别[n(%)]0.0050.945
女6 413(52.4)5 770(52.4)643(52.2)
男5 833(47.6)5 245(47.6)588(47.8)
居住地[n(%)]5.8000.016
城市4 437(36.2)4 030(36.6)407(33.1)
农村7 809(63.8)6 985(63.4)824(66.9)
婚姻状况[n(%)]209.877<0.001
已婚或有伴侣10 707(87.4)9 791(88.9)916(74.4)
其他1 539(12.6)1 224(11.1)315(25.6)
受教育水平[n(%)]55.212<0.001
初中及以下10 981(89.7)9 802(89.0)1 179(95.8)
高中1 102(9.0)1 058(9.6)44(3.6)
大学及以上163(1.3)155(1.4)8(0.6)
吸烟状况[n(%)]2.7400.254
从不吸烟7 372(60.4)6 634(60.4)738(60.7)
过去吸烟1 059(8.7)940(8.6)119(9.8)
当前吸烟3 769(30.9)3 410(31.0)359(29.5)
饮酒频率[n(%)]37.306<0.001
不饮酒8 201(70.7)7 282(69.8)919(78.3)
每月<1次967(8.3)888(8.5)79(6.7)
每月≥1次2 439(21.0)2 263(21.7)176(15.0)
BMI分类[n(%)]164.025<0.001
体重过轻803(6.6)632(5.8)171(14.4)
正常体重6 415(53.1)5 745(52.7)670(56.4)
超重3 488(28.8)3 252(29.8)236(19.9)
肥胖1 386(11.5)1 275(11.7)111(9.3)
抑郁症状[n(%)]164.925<0.001
无7 420(62.3)6 899(64.2)521(44.9)
有4 487(37.7)3 848(35.8)639(55.1)
慢性病数量[n(%)]51.139<0.001
0种3 754(31.4)3 469(32.2)285(23.6)
1种3 527(29.5)3 181(29.6)346(28.7)
≥2种4 687(39.2)4 111(38.2)576(47.7)
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研究对象的基线特征

, figureFileSmall=null, figureFileBig=null, tableContent=
特征总体正常握力低握力t/χ2值P值
年龄（岁）58.89±9.3057.98±8.7867.04±9.84-30.951<0.001
性别[n(%)]0.0050.945
女6 413(52.4)5 770(52.4)643(52.2)
男5 833(47.6)5 245(47.6)588(47.8)
居住地[n(%)]5.8000.016
城市4 437(36.2)4 030(36.6)407(33.1)
农村7 809(63.8)6 985(63.4)824(66.9)
婚姻状况[n(%)]209.877<0.001
已婚或有伴侣10 707(87.4)9 791(88.9)916(74.4)
其他1 539(12.6)1 224(11.1)315(25.6)
受教育水平[n(%)]55.212<0.001
初中及以下10 981(89.7)9 802(89.0)1 179(95.8)
高中1 102(9.0)1 058(9.6)44(3.6)
大学及以上163(1.3)155(1.4)8(0.6)
吸烟状况[n(%)]2.7400.254
从不吸烟7 372(60.4)6 634(60.4)738(60.7)
过去吸烟1 059(8.7)940(8.6)119(9.8)
当前吸烟3 769(30.9)3 410(31.0)359(29.5)
饮酒频率[n(%)]37.306<0.001
不饮酒8 201(70.7)7 282(69.8)919(78.3)
每月<1次967(8.3)888(8.5)79(6.7)
每月≥1次2 439(21.0)2 263(21.7)176(15.0)
BMI分类[n(%)]164.025<0.001
体重过轻803(6.6)632(5.8)171(14.4)
正常体重6 415(53.1)5 745(52.7)670(56.4)
超重3 488(28.8)3 252(29.8)236(19.9)
肥胖1 386(11.5)1 275(11.7)111(9.3)
抑郁症状[n(%)]164.925<0.001
无7 420(62.3)6 899(64.2)521(44.9)
有4 487(37.7)3 848(35.8)639(55.1)
慢性病数量[n(%)]51.139<0.001
0种3 754(31.4)3 469(32.2)285(23.6)
1种3 527(29.5)3 181(29.6)346(28.7)
≥2种4 687(39.2)4 111(38.2)576(47.7)
), ArticleFig(id=1324077651022979265, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324077642839892106, language=EN, label=Table 2, caption=

Association of handgrip strength status with the baseline ADL

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握力状态模型1a模型2b
β(95%CI)P值β (95%CI)P值
ADL
正常握力参照组-参照组-
低握力1.100(1.015~1.185)<0.0010.607(0.523~0.690)<0.001
BADL
正常握力参照组-参照组-
低握力0.493(0.448~0.538)<0.0010.270(0.225~0.315)<0.001
IADL
正常握力参照组-参照组-
低握力0.613(0.563~0.662)<0.0010.324(0.275~0.372)<0.001
), ArticleFig(id=1324077651111059650, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324077642839892106, language=CN, label=表2, caption=

握力与基线时日常生活活动能力的关联

, figureFileSmall=null, figureFileBig=null, tableContent=
握力状态模型1a模型2b
β(95%CI)P值β (95%CI)P值
ADL
正常握力参照组-参照组-
低握力1.100(1.015~1.185)<0.0010.607(0.523~0.690)<0.001
BADL
正常握力参照组-参照组-
低握力0.493(0.448~0.538)<0.0010.270(0.225~0.315)<0.001
IADL
正常握力参照组-参照组-
低握力0.613(0.563~0.662)<0.0010.324(0.275~0.372)<0.001
), ArticleFig(id=1324077651203334339, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324077642839892106, language=EN, label=Table 3, caption=

Association of handgrip strength with ADL decline

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握力状态模型1a模型2b
β (95%CI)P值β (95%CI)P值
ADL
时间（年）0.074(0.069~0.079)<0.0010.061(0.056~0.066)<0.001
正常握力×时间参照组-参照组-
低握力×时间0.090(0.073~0.107)<0.0010.085(0.068~0.101)<0.001
BADL
时间（年）0.039(0.036~0.041)<0.0010.032(0.030~0.035)<0.001
正常握力×时间参照组-参照组-
低握力×时间0.042(0.033~0.052)<0.0010.040(0.031~0.050)<0.001
IADL
时间（年）0.034(0.031~0.037)<0.0010.027(0.024~0.030)<0.001
正常握力×时间参照组-参照组-
低握力×时间0.043(0.034~0.053)<0.0010.041(0.031~0.050)<0.001
), ArticleFig(id=1324077651291414724, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324077642839892106, language=CN, label=表3, caption=

握力和日常生活活动能力衰退的关联

, figureFileSmall=null, figureFileBig=null, tableContent=
握力状态模型1a模型2b
β (95%CI)P值β (95%CI)P值
ADL
时间（年）0.074(0.069~0.079)<0.0010.061(0.056~0.066)<0.001
正常握力×时间参照组-参照组-
低握力×时间0.090(0.073~0.107)<0.0010.085(0.068~0.101)<0.001
BADL
时间（年）0.039(0.036~0.041)<0.0010.032(0.030~0.035)<0.001
正常握力×时间参照组-参照组-
低握力×时间0.042(0.033~0.052)<0.0010.040(0.031~0.050)<0.001
IADL
时间（年）0.034(0.031~0.037)<0.0010.027(0.024~0.030)<0.001
正常握力×时间参照组-参照组-
低握力×时间0.043(0.034~0.053)<0.0010.041(0.031~0.050)<0.001
), ArticleFig(id=1324077651383689413, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324077642839892106, language=EN, label=Table 4, caption=

Number and percentage for the transitions of handgrip strength status from baseline to the second survey

, figureFileSmall=null, figureFileBig=null, tableContent=
基线握力状态第二次调查时握力状态[n(%)]
正常握力低握力
正常握力7 232(83.42%)617(7.12%)
低握力496(5.72%)324(3.74%)
), ArticleFig(id=1324077651488547014, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324077642839892106, language=CN, label=表4, caption=

基线至第二次调查期间握力状态转变的例数及百分比

, figureFileSmall=null, figureFileBig=null, tableContent=
基线握力状态第二次调查时握力状态[n(%)]
正常握力低握力
正常握力7 232(83.42%)617(7.12%)
低握力496(5.72%)324(3.74%)
), ArticleFig(id=1324077651555655879, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324077642839892106, language=EN, label=Table 5, caption=

Association of handgrip strength status transitions with ADL decline

, figureFileSmall=null, figureFileBig=null, tableContent=
握力状态转变模型1a模型2b
β (95%CI)P值β (95%CI)P值
ADL
时间（年）0.067(0.061~0.073)<0.0010.056(0.050~0.062)<0.001
握力持续正常×时间参照组-参照组-
正常握力转为低握力×时间0.089(0.066~0.111)<0.0010.081(0.059~0.103)<0.001
低握力转为正常握力×时间0.060(0.036~0.084)<0.0010.060(0.037~0.084)<0.001
握力持续低×时间0.160(0.127~0.194)<0.0010.153(0.120~0.185)<0.001
BADL
时间（年）0.034(0.031~0.038)<0.0010.029(0.026~0.032)<0.001
握力持续正常×时间参照组-参照组-
正常握力转为低握力×时间0.038(0.025~0.050)<0.0010.034(0.022~0.046)<0.001
低握力转为正常握力×时间0.031(0.018~0.044)<0.0010.031(0.018~0.044)<0.001
握力持续低×时间0.073(0.055~0.091)<0.0010.070(0.052~0.088)<0.001
IADL
时间（年）0.032(0.029~0.035)<0.0010.026(0.023~0.029)<0.001
握力持续正常×时间参照组-参照组-
正常握力转为低握力×时间0.046(0.034~0.059)<0.0010.042(0.030~0.054)<0.001
低握力转为正常握力×时间0.028(0.014~0.042)<0.0010.029(0.015~0.042)<0.001
握力持续低×时间0.081(0.063~0.100)<0.0010.077(0.059~0.096)<0.001
), ArticleFig(id=1324077651652124872, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324077642839892106, language=CN, label=表5, caption=

握力状态转变与日常生活活动能力衰退的关联

, figureFileSmall=null, figureFileBig=null, tableContent=
握力状态转变模型1a模型2b
β (95%CI)P值β (95%CI)P值
ADL
时间（年）0.067(0.061~0.073)<0.0010.056(0.050~0.062)<0.001
握力持续正常×时间参照组-参照组-
正常握力转为低握力×时间0.089(0.066~0.111)<0.0010.081(0.059~0.103)<0.001
低握力转为正常握力×时间0.060(0.036~0.084)<0.0010.060(0.037~0.084)<0.001
握力持续低×时间0.160(0.127~0.194)<0.0010.153(0.120~0.185)<0.001
BADL
时间（年）0.034(0.031~0.038)<0.0010.029(0.026~0.032)<0.001
握力持续正常×时间参照组-参照组-
正常握力转为低握力×时间0.038(0.025~0.050)<0.0010.034(0.022~0.046)<0.001
低握力转为正常握力×时间0.031(0.018~0.044)<0.0010.031(0.018~0.044)<0.001
握力持续低×时间0.073(0.055~0.091)<0.0010.070(0.052~0.088)<0.001
IADL
时间（年）0.032(0.029~0.035)<0.0010.026(0.023~0.029)<0.001
握力持续正常×时间参照组-参照组-
正常握力转为低握力×时间0.046(0.034~0.059)<0.0010.042(0.030~0.054)<0.001
低握力转为正常握力×时间0.028(0.014~0.042)<0.0010.029(0.015~0.042)<0.001
握力持续低×时间0.081(0.063~0.100)<0.0010.077(0.059~0.096)<0.001
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握力及其动态变化与中国中老年人日常生活活动能力衰退的关系：一项基于CHARLS的纵向研究
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宋林阳 1 , 祁婧 1 , 重竺君 1 , 邱培媛 1 , 万洋 2
现代预防医学 | 流行病与统计方法 2026,53(6): 973-980
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现代预防医学 |流行病与统计方法 2026 , 53 (6) : 973 -980
握力及其动态变化与中国中老年人日常生活活动能力衰退的关系：一项基于CHARLS的纵向研究
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宋林阳1, 祁婧1, 重竺君1, 邱培媛1, 万洋2
作者信息
  • 1.四川大学华西公共卫生学院/华西第四医院 流行病与卫生统计学系，四川 成都 610041
  • 2.四川大学华西公共卫生学院/华西第四医院 神经内科
通讯作者:
万洋，E-mail:
作者简介:

宋林阳（2001—），男，硕士在读，研究方向：卫生统计方法与应用

Association of handgrip strength and its changes with activities of daily living decline among middle-aged and older adults in China: a longitudinal study based on the CHARLS
Lin-yang SONG1, Jing QI1, Zhu-jun CHONG1, Pei-yuan QIU1, Yang WAN2
Affiliations
  • Department of Epidemiology and Health Statistics, West China School of Public Health/West China Fourth Hospital, Sichuan University, Chengdu, Sichuan 610041, China
出版时间: 2026-03-25 doi: 10.20043/j.cnki.MPM.202512076
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摘要
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目的

探究中国中老年人握力及其变化与日常生活活动能力（activities of daily living, ADL）衰退的关联。

方法

本研究使用了中国健康与养老追踪调查2011—2020年的5次调查数据。依据亚洲肌肉减少症工作组共识，男性握力低于28 kg和女性握力低于18 kg定义为低握力。根据基线到第二次调查期间握力的变化，参与者被分为四组：握力持续正常，正常握力转为低握力，低握力转为正常握力和握力持续低。ADL评分为个体在完成日常活动时存在困难的项目数量，分数越高代表能力越差。采用线性混合效应模型分析握力及其变化模式与ADL衰退的关联。

结果

相较于正常握力者，低握力者基线ADL得分更高（β=0.607, 95% CI: 0.523~0.690, P<0.001），并且随访期间ADL得分增长更快（β = 0.085, 95% CI: 0.068~0.101, P<0.001）。与握力持续正常者相比，持续保持低握力者ADL得分增长最快（β=0.153, 95% CI: 0.120~0.185, P<0.001），其次为从正常握力转为低握力者（β=0.081, 95% CI: 0.059~0.103, P<0.001）。

结论

较低的握力与ADL加速衰退有关。握力的动态变化对ADL衰退风险评估也具有重要价值。定期监测握力及其变化有助于预防和延缓ADL衰退。

握力  /  日常生活活动能力  /  线性混合效应模型  /  CHARLS
Objective

To investigate the association between handgrip strength (HGS), its transitions, and the decline of activities of daily living (ADL) among middle-aged and older adults in China.

Methods

This study utilized data from waves 1 to 5 (2011 to 2020) of the China Health and Retirement Longitudinal Study (CHARLS). According to the Asian Work Group for Sarcopenia 2019 consensus, low HGS was defined as <28 kg for males and <18 kg for females. Based on the changes in HGS status from baseline to the second survey, participants were classified into four groups: stable normal HGS, normal HGS to low HGS, low HGS to normal HGS, and stable low HGS. ADL disability was measured by the number of daily activities with difficulty, with higher scores indicating poorer functional ability. Linear mixed-effect models were employed to investigate the association of handgrip strength and its transition patterns with ADL decline.

Results

Individuals with low HGS exhibited a higher level of ADL disability (β=0.607, 95% CI: 0.523-0.690, P<0.001) and a faster progression of ADL disability (β=0.085,95% CI: 0.068-0.101, P<0.001) compared to those with normal HGS. Compared with individuals with stable normal HGS, those with stable low HGS (β=0.153, 95% CI: 0.120-0.185, P<0.001) experienced the most rapid progression of ADL disability, followed by those transitioning from normal HGS to low HGS (β=0.081, 95% CI: 0.059-0.103, P<0.001).

Conclusion

Lower HGS is associated with accelerated ADL disability progression. Dynamic changes in handgrip strength also provide significant prognostic value for assessing the risk of ADL decline. Regular monitoring of handgrip strength and its changes may aid in the prevention and delay of ADL decline.

Handgrip strength  /  ADL  /  Linear mixed-effect model  /  CHARLS
宋林阳, 祁婧, 重竺君, 邱培媛, 万洋. 握力及其动态变化与中国中老年人日常生活活动能力衰退的关系：一项基于CHARLS的纵向研究. 现代预防医学, 2026 , 53 (6) : 973 -980 . DOI: 10.20043/j.cnki.MPM.202512076
Lin-yang SONG, Jing QI, Zhu-jun CHONG, Pei-yuan QIU, Yang WAN. Association of handgrip strength and its changes with activities of daily living decline among middle-aged and older adults in China: a longitudinal study based on the CHARLS[J]. Modern Preventive Medicine, 2026 , 53 (6) : 973 -980 . DOI: 10.20043/j.cnki.MPM.202512076
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随着人口预期寿命的不断延长及生育率的降低，老龄化问题已经成为世界范围内的重大挑战。1982年至2023年间，我国60岁及以上人口的占比从7.54%增长至21.07%[1]。日常生活活动能力（activities of daily living, ADL）是评估老年人健康状况的重要指标，包括反映个人基本自理能力的基本日常生活活动能力（basic activities of daily living, BADL）以及衡量社会功能的工具性日常生活活动能力（instrumental activities of daily living, IADL）。一项Meta分析指出，我国60岁及以上的老年群体中，ADL受损的比例为34%[2]。ADL受损与抑郁[3]、认知障碍[4]以及更高的死亡率[5]等多种不良结局相关，会给家庭照护者和社会医疗服务体系造成沉重的负担。然而，已有研究证实，通过恰当的干预可有效改善老年人的ADL[6]。因此，探究ADL受损的早期生物标志物和危险因素，对于制定延缓其衰退的干预和管理策略至关重要。
握力（Handgrip strength, HGS）是一项操作简便、成本低廉的评估指标，具有重要的临床价值。握力降低与心血管疾病、痴呆等多种疾病发生风险升高及死亡率增加均存在显著关联[7-8]。多项研究[9-11]也发现，较低的握力与ADL受损相关。既往研究ADL受损多被定义为单次评估中完成任何一项活动或任务存在困难，未关注其长期演变趋势。此外，握力的动态变化对ADL衰退的影响也仍不明确。因此，本研究基于中国健康与养老追踪调查（China Health and Retirement Longitudinal Study, CHARLS）的纵向数据，探究握力及其变化模式对ADL衰退的影响，以明确握力与ADL长期变化的关联，并为早期识别高危人群提供依据。
1　资料与方法
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1.1　资料来源和研究人群
本研究利用了中国健康与养老追踪调查2011至2020年间5轮调查数据[12]。该研究于2011年进行基线调查，此后相继于2013年、2015年、2018年和2020年开展了4次随访。研究对象的选取流程如图1所示。在参加基线调查的17 708名受访者中，首先排除了年龄缺失和<45岁的参与者。在分析基线握力与ADL衰退的关联时，进一步排除了基线握力测量值缺失、基线BADL和IADL存在缺失值以及缺少随访评估的受访者，共纳入12 246名研究对象。在进一步分析握力状态转变对ADL衰退的影响时，额外排除了第二次调查握力测量值缺失的参与者，共有8 669名研究对象被纳入此部分分析。
1.2　握力评估
握力通过握力计测量。在测量过程中，受试者肘部弯曲呈直角，每只手均完成2次测量。取个体左手或右手握力的最大值作为其握力值用于分析。依据2019版亚洲肌肉减少症工作组共识[13]，男性握力小于28 kg或女性握力小于18 kg被定义为低握力。根据基线握力测量值，将参与者分为2组：正常握力组和低握力组。此外，基于基线到第二次调查的握力状态变化，将参与者进一步分为4组：（1）握力持续正常；（2）正常握力转为低握力；（3）低握力转为正常握力；（4）握力持续低。
1.3　日常生活活动能力
ADL根据参与者自我报告的完成日常活动或任务的困难情况进行评估，具体包括BADL和IADL[11, 14]。其中，BADL包括6项活动，分别是吃饭、上下床、洗澡、穿衣、上厕所和控制大小便。IADL由5项活动评估，具体包括管理财务、吃药、购物、做饭和做家务。对于每项活动，参与者报告没有困难记0分，有困难或无法完成则记1分。BADL和IADL得分分别为对应项目评分的总和，而ADL得分则为上述所有项目评分的总和。因此，ADL、BADL和IADL得分反映了存在困难的日常活动项目数量，得分范围分别为0~11、0~6和0~5，分数越高代表身体活动能力越差。
1.4　协变量
本研究考虑了潜在的混杂因素，包括年龄、性别、居住地、婚姻、受教育程度、吸烟、饮酒、体质指数（BMI）、抑郁症状和慢性病数量。具体而言，居住地包括城市和农村。婚姻状况分为2类：已婚或有伴侣，及其他（未婚、分居、离婚或丧偶）。教育水平包括初中及以下、高中、大学及以上。吸烟状况包括3类：从不吸烟、过去吸烟和目前仍在吸烟。饮酒频率包括不饮酒、<1次/月，和≥1次/月。BMI依据我国标准分为：体重过轻（<18.5 kg/m2）、正常体重（18.5≤BMI<24.0 kg/m2）、超重（24.0≤BMI<28.0 kg/m2）和肥胖（≥28 kg/m2）[15]。采用流行病学研究中心抑郁量表（CESD-10）评估抑郁症状，得分≥10认为存在抑郁症状[16]。慢性病数量分为3类：无、1种和≥2种。
1.5　统计分析
在描述性分析中，连续型变量和分类变量分别以均值（标准差）和频数（百分比）表示。连续型变量的组间比较采用t检验，分类变量的组间比较使用卡方检验。
对于每位研究对象，ADL的多次测量构成了重复测量资料。为探究基线握力与ADL衰退的关联，本研究使用线性混合效应模型，以重复测量的ADL得分作为结局变量，计算回归系数（β）和95%置信区间（95% CI）。模型1纳入基线握力状态、随访时间（距基线调查的间隔时间，以年为单位）及两者的交互项。模型的截距和斜率均设置为随机效应，允许基线时的ADL得分与随访期间ADL得分的变化率在个体间可以存在差异。交互项的回归系数表示，在随访期间，正常握力组和低握力组之间ADL年度变化率的差异。为减少混杂偏倚，模型2在模型1的基础上进一步调整了前文所述的协变量。对于BADL和IADL，分别将其作为结局变量重复了上述分析。进一步，本研究采用上述相同的分析策略探究了握力状态转变对ADL衰退的影响。
协变量的缺失值通过多重插补法进行处理。本研究的统计检验均为双侧检验，检验水准α=0.05。数据处理和分析均使用R 4.3.3完成。
2　结果
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2.1　研究人群的基线特征
本研究共纳入12 246名研究对象，平均年龄为（58.89±9.30）岁，其中女性有6 413（52.4%）人。除性别与吸烟状况外，其余协变量在正常握力组和低握力组之间的差异均存在统计学意义（表1）。
2.2　基线握力与基线ADL的关联
与正常握力的参与者相比，低握力者基线时ADL的得分更高（β=0.607, 95% CI: 0.523~0.690, P<0.001）。在BADL和IADL中也观察到类似的结果。低握力者的BADL得分（β=0.270, 95% CI: 0.225~0.315, P<0.001）和IADL得分（β=0.324, 95% CI: 0.275~0.372, P<0.001）均更高。见表2。
2.3　基线握力与ADL衰退的关联
在随访期间，低握力的参与者比正常握力者ADL得分增长更快，每年额外增长0.085（95% CI: 0.068~0.101）；对于BADL和IADL，低握力者每年分别额外增长0.040（95% CI: 0.031~0.050）和0.041（95% CI: 0.031~0.050）（表3）。不同握力状态参与者ADL、BADL及IADL得分的变化轨迹见图2。
2.4　握力状态转变与ADL衰退的关联
7 232（83.42%）名参与者的握力持续保持正常，617（7.12%）名参与者从正常握力转变为低握力，496（5.72%）名参与者从低握力转变为正常握力，以及324（3.74%）名参与者持续处于低握力状态（表4）。握力状态转变对ADL衰退的影响如表5所示。在基线握力正常的参与者中，握力转变为低握力者相较于仍保持正常握力者的ADL（β=0.081, 95% CI: 0.059~0.103, P<0.001）、BADL（β=0.034, 95% CI: 0.022~0.046, P<0.001）和IADL（β=0.042, 95% CI: 0.030~0.054, P<0.001）得分在随访期间增长更快。与握力持续正常者相比，由低握力转变为正常握力者的ADL（β=0.060, 95% CI: 0.037~0.084, P<0.001）、BADL（β=0.031, 95% CI: 0.018~0.044,P<0.001）和IADL（β=0.029, 95% CI: 0.015~0.042, P<0.001）得分也增长较快。此外，在随访期间，握力持续低者的ADL（β=0.153, 95% CI: 0.120~0.185, P<0.001）、BADL（β=0.070, 95% CI: 0.052~0.088, P < 0.001）和IADL（β=0.077, 95% CI: 0.059~0.096, P<0.001）得分增长速度最快。不同握力状态转变组参与者ADL、BADL及IADL得分的变化轨迹见图3。
3　讨论
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本研究基于CHARLS的纵向数据，分析了我国中老年人握力与ADL衰退的关联，并进一步揭示了握力状态随时间的动态变化对ADL衰退的影响。
握力是预测ADL功能障碍及其衰退的重要指标。研究结果表明，与正常握力组参与者相比，低握力组在基线时的ADL功能障碍更严重。并且在随访期间，低握力组的ADL衰退速度更快。这些发现与既往研究中较低水平握力与ADL受损相关的结论一致[10]。此外，BADL多为基础活动，IADL则涉及更复杂的功能和活动[11, 17]。Dai等的研究发现，较低的握力与BADL的关联强度高于IADL[11]。考虑到BADL和IADL的区别，本研究还分别探究了握力与BADL和IADL衰退的关联。结果表明，与正常握力组相比，低握力组BADL和IADL衰退速度均更快，这也进一步验证了握力对日常生活活动能力衰退的普遍影响。
本研究还发现，握力的动态变化对ADL衰退风险评估具有重要价值。相较于基线和第二次调查时握力均正常的参与者，从正常握力转变为低握力者的ADL衰退速度更快，这一结果进一步强调了握力降低与ADL衰退的关联。此外，与握力持续正常者相比，持续处于低握力状态的参与者ADL衰退的速度最快。这一发现提示，定期监测握力变化可作为临床识别ADL衰退高风险人群的有效手段。
握力与ADL受损的关联机制涉及多个维度。首先，多数日常生活活动的完成依赖手部功能参与，而手部灵活性与肌肉力量的下降会直接制约这些活动的完成。其次，握力降低可能提示关节和肌肉存在损伤。同时，握力测量过程是一项复杂的协调活动，既依赖多组运动单位的参与，也涉及神经系统的精细调节[18]。既往研究表明，较低的握力与认知功能障碍[19]、痴呆[20]和脑卒中[21]的发生风险升高有关。而神经系统或脑部疾病可能会降低个体执行日常活动的协调性，进而影响其完成[10, 22]。此外，低握力和ADL受损还可能通过炎症这一共同生理机制相关联。有证据表明，炎症标志物水平升高可导致肌肉质量和力量下降[23]。同时，全身性炎症还与ADL受损有关[24]。
本研究使用了具有全国代表性的纵向调查数据，样本量大，结果具有较高可靠性。但本研究也存在一些局限性。首先，ADL评估均基于自我报告，可能存在回忆偏倚，不过该方法在人群研究中已被广泛采用[25]。其次，部分参与者因失访而被排除在分析之外，可能引起选择偏倚。此外，即便分析中已对多个协变量进行了调整，但依然可能存在未被纳入的残余混杂因素，例如饮食。未来研究可进一步优化评估方法、控制潜在混杂，并深入探索关联机制。
本研究的发现揭示了握力对ADL衰退的重要预测价值。较低水平握力不仅与基线时更严重的ADL功能障碍相关，还与随访期间ADL的加速衰退有关。握力作为便捷、无创的客观指标，可有效筛查ADL衰退高危人群，为早期干预提供关键窗口期。此外，定期监测握力还有助于追踪个体肌肉力量的变化，从而及时调整管理和干预策略，具有重要的临床和公共卫生意义。
基金
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  • 国家自然科学基金(72174133)
文献
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参考文献 引证文献
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2026年第53卷第6期
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doi: 10.20043/j.cnki.MPM.202512076
  • 接收时间：2025-12-04
  • 首发时间：2026-11-02
  • 出版时间：2026-03-25
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  • 收稿日期：2025-12-04
基金
国家自然科学基金(72174133)
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    1.四川大学华西公共卫生学院/华西第四医院 流行病与卫生统计学系，四川 成都 610041
    2.四川大学华西公共卫生学院/华西第四医院 神经内科

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