NICM Health Research Institute, School of Science and Health, University of Western Sydney, Sydney. New South Wales, Australia.
Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom.
JAMA Psychiatry. 2018 Jul 1;75(7):740-746. doi: 10.1001/jamapsychiatry.2018.0503.
Objective physical fitness measures, such as handgrip strength, are associated with physical, mental, and cognitive outcomes in the general population. Although people with mental illness experience reduced physical fitness and cognitive impairment, the association between muscular strength and cognition has not been examined to date.
To determine associations between maximal handgrip strength and cognitive performance in people with major depression or bipolar disorder and in healthy controls.
DESIGN, SETTING, AND PARTICIPANTS: In a multicenter, population-based study conducted between February 13, 2005, and October 1, 2010, in the United Kingdom, cross-sectional analysis was conducted of baseline data from 110 067 participants in the UK Biobank. Data analysis was performed between August 3 and August 18, 2017. Invitations were mailed to approximately 9.2 million UK homes, recruiting 502 664 adults, all aged 37 to 73 years. Clinically validated measures were used to identify individuals with major recurrent depression (moderate or severe) or bipolar disorder (type I or type II) and healthy controls (those with no indication of present or previous mood disorders).
Handgrip dynamometry was used to measure muscular function. Cognitive functioning was assessed using computerized tasks of reaction time, visual memory, number memory, reasoning, and prospective memory. Generalized linear mixed models assessed the association between handgrip strength and cognitive performance, controlling for age, educational level, sex, body weight, and geographic region.
Of the 110 067 participants, analyses included 22 699 individuals with major depression (mean [95% range] age, 55.5 [41-68] years; 7936 [35.0%] men), 1475 with bipolar disorder (age, 54.4 [41-68] years; 748 [50.7%] men), and 85 893 healthy controls (age, 53.7 [41-69] years; 43 000 [50.0%] men). In those with major depression, significant positive associations (P < .001) between maximal handgrip strength and improved performance on all 5 cognitive tasks were found, including visual memory (coefficient, -0.146; SE, 0.014), reaction time (coefficient, -0.036; SE, 0.002), reasoning (coefficient, 0.213; SE, 0.02), number memory (coefficient, 0.160; SE, 0.023), and prospective memory (coefficient, 0.341; SE, 0.024). Similar results were found in healthy controls. Among participants with bipolar disorder, handgrip strength was positively associated with improved visual memory (coefficient, -0.129; SE, 0.052; P = .01), reaction time (coefficient, -0.047; SE, 0.007; P < .001), prospective memory (coefficient, 0.262; SE, 0.088; P = .003), and reasoning (coefficient, 0.354; SE, 0.08; P < .001).
Grip strength may provide a useful indicator of cognitive impairment in people with major depression and bipolar disorder. Future research should investigate causality, assess the functional implications of handgrip strength in psychiatric populations, and examine how interventions to improve muscular fitness affect neurocognitive status and socio-occupational functioning.
客观的体能指标，如握力，与普通人群的身体、心理和认知结果相关。尽管患有精神疾病的人会出现体能下降和认知障碍，但迄今为止，肌肉力量与认知之间的关联尚未得到研究。
确定在患有重度抑郁症或双相情感障碍的人群以及健康对照组中，最大握力与认知表现之间的关联。
设计、地点和参与者：在 2005 年 2 月 13 日至 2010 年 10 月 1 日期间在英国进行的一项多中心、基于人群的研究中，对英国生物银行参与者的基线数据进行了横断面分析。数据分析于 2017 年 8 月 3 日至 8 月 18 日进行。向大约 920 万户英国家庭邮寄了邀请函，招募了 502664 名成年人，年龄均在 37 至 73 岁之间。使用经过临床验证的措施来识别有重度复发性抑郁症（中度或重度）或双相情感障碍（I 型或 II 型）的个体以及健康对照组（没有当前或既往情绪障碍迹象的个体）。
使用握力测力计测量肌肉功能。使用计算机化的反应时间、视觉记忆、数字记忆、推理和前瞻性记忆任务评估认知功能。广义线性混合模型评估了握力与认知表现之间的关联，控制了年龄、教育水平、性别、体重和地理位置。
在 110067 名参与者中，分析包括 22699 名重度抑郁症患者（平均[95%范围]年龄为 55.5[41-68]岁；7936[35.0%]为男性）、1475 名双相情感障碍患者（年龄为 54.4[41-68]岁；748[50.7%]为男性）和 85893 名健康对照组（年龄为 53.7[41-69]岁；43000[50.0%]为男性）。在重度抑郁症患者中，发现最大握力与所有 5 项认知任务表现的显著正相关（P < .001），包括视觉记忆（系数，-0.146；SE，0.014）、反应时间（系数，-0.036；SE，0.002）、推理（系数，0.213；SE，0.02）、数字记忆（系数，0.160；SE，0.023）和前瞻性记忆（系数，0.341；SE，0.024）。在健康对照组中也发现了类似的结果。在双相情感障碍患者中，握力与视觉记忆（系数，-0.129；SE，0.052；P = .01）、反应时间（系数，-0.047；SE，0.007；P < .001）、前瞻性记忆（系数，0.262；SE，0.088；P = .003）和推理（系数，0.354；SE，0.08；P < .001）的改善呈正相关。
握力可能是重度抑郁症和双相情感障碍患者认知障碍的有用指标。未来的研究应调查因果关系，评估精神病患者握力的功能意义，并研究改善肌肉健康的干预措施如何影响神经认知状态和社会职业功能。
