Individuals with acromegaly (IwA) may have alterations in skeletal muscles. Isokinetic testing is the standard method to assess muscle performance through objective, reliable, and reproducible measures.
OBJECTIVES:
To assess knee muscles performance of IwA with active and controlled disease and to correlate the findings with hormone levels, handgrip strength (HGS), general fatigue, and quality of life.
METHODS:
Sixteen men with acromegaly (MwA), 21 women with acromegaly (WwA), and 21 healthy controls (nine men and 12 women) underwent knee isokinetic dynamometry at 75 and 240°/s as well as isometric dynamometry to assess HGS. The subjects were also assessed using the Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F) scale, the Fatigue Impact Scale (FIS), and the Acromegaly Quality of Life Questionnaire (AcroQoL).
RESULTS:
Compared with healthy controls, MwA and WwA exhibited significant reductions in the peak moment (PM), maximum work repetition, and total work for both extension and flexion at both angular velocities. There were significant differences for the agonist/antagonist ratio at 75°/s in MwA (44% for active disease vs. 53% for controlled disease vs. 67% for the control group; P = 0.0002) and in WwA (48% for active disease vs. 58% for controlled disease vs. 66% for the control group; P = 0.0003). These patients also exhibited decreased HGS values and FACIT-F scores and increased FIS scores compared with healthy controls. There were significant correlations between measures obtained by isokinetic dynamometry, growth hormone (GH) levels, HGS values, and scores on the general fatigue questionnaires. However, GH levels were more strongly correlated with the isokinetic variables in MwA than in WwA.
References
1.
ColaoA, FeroneD, MarzulloP, LombardiG. Systemic complications of acromegaly: Epidemiology, pathogenesis, and management. Endocr Rev. 2004; 25(1): 102-52.
2.
HoldawayIM, RajasooryaC. Epidemiology of acromegaly. Pituitary. 1999; 2(1): 29-41.
3.
MøllerN, JørgensenJO. Effects of growth hormone on glucose, lipid, and protein metabolism in human subjects. Endocr Rev. 2009; 30(2): 152-77.
4.
KhaleeliAA, LevyRD, EdwardsRH, McPhailG, MillsKR, RoundJM, et al. The neuromuscular features of acromegaly: A clinical and pathological study. J Neurol Neurosurg Psychiatry. 1984; 47(9): 1009-15.
5.
Guedes da SilvaDP, GuimarãesFS, DiasCM, Guimarães SdeA, KasukiL, GadelhaMR, et al. On the functional capacity and quality of life of patients with acromegaly: Are they candidates for rehabilitation programs?J Phys Ther Sci. 2013; 25(11): 1497-501.
6.
NagulesparenM, TrickeyR, DaviesMJ, JenkinsJS. Muscle changes in acromegaly. Br Med J. 1976; 2(6041): 914-5.
7.
ColaoA, AmatoG, PedroncelliAM, BaldelliR, GrottoliS, GascoV, et al. Gender- and age-related differences in the endocrine parameters of acromegaly. J Endocrinol Invest. 2002; 25(6): 532-8.
8.
GatfordKL, EganAR, ClarkeIJ, OwensPC. Sexual dimorphism of the somatotrophic axis. J Endocrinol. 1998; 157(3): 373-89.
9.
SucunzaN, BarahonaMJ, ResminiE, Fernández-RealJM, FarreronsJ, LluchP, et al. Gender dimorphism in body composition abnormalities in acromegaly: Males are more affected than females. Eur J Endocrinol. 2008; 159(6): 773-9.
10.
DvirZ. Clinical applicability of isokinetics: A review. Clin Biomech. 1991; 6(3): 133-44.
11.
HarboT, BrincksJ, AndersenH. Maximal isokinetic and isometric muscle strength of major muscle groups related to age, body mass, height, and sex in 178 healthy subjects. Eur J Appl Physiol. 2012; 112(1): 267-75.
12.
StarkT, WalkerB, PhillipsJK, FejerR, BeckR. Hand-held dynamometry correlation with the gold standard isokinetic dynamometry: a systematic review. PM R. 2011; 3(5): 472-9.
13.
NordezA, CasariP, CornuC. Accuracy of Biodex system 3 pro computerized dynamometer in passive mode. Med Eng Phys. 2008; 30(7): 880-7.
14.
MartinHJ, YuleV, SyddallHE, DennisonEM, CooperC, Aihie SayerA. Is hand-held dynamometry useful for the measurement of quadriceps strength in older people? A comparison with the gold standard Bodex dynamometry. Gerontology. 2006; 52(3): 154-9.
15.
TsepisE, GiakasG, VagenasG, GeorgoulisA. Frequency content asymmetry of the isokinetic curve between ACL deficient and healthy knee. J Biomech. 2004; 37(6): 857-64.
16.
FelsonDT. Osteoarthritis of knee. New Engl J Med. 2006; 354(8): 841-8.
17.
SlemendaC, HeilmanDK, BrandtKD, KatzP, MazzucaSA, BraunsteinEM, et al. Reduced quadriceps strength relative to body weight: A risk factor for knee osteoarthritis in women?Arthritis Rheum. 1998; 41(11): 1951-9.
18.
TunstallH, MullineauxDR, VernonT. Criterion validity of an isokinetic dynamometer to assess shoulder function in tennis players. Sports Biomech. 2005; 4(1): 101-11.
19.
GiustinaA, ChansonP, BronsteinMD, KlibanskiA, LambertsS, CasanuevaFF, et al. A consensus on criteria for cure of acromegaly. J Clin Endocrinol Metab. 2010; 95(7): 3141-8.
20.
CraigCL, MarshallAL, SjöströmM, BaumanAE, BoothML, AinsworthBE, et al. International physical activity questionnaire: 12-country reliability and validity. Med Sci Sports Exerc. 2003; 35(8): 1381-95.
21.
WebsterK, CellaD, YostK. The functional assessment of chronic illness therapy (FACIT) measurement system: Properties, applications, and interpretation. Health Qual Life Outcomes. 2003; 1: 79.
BadiaX, WebbSM, PrietoL, LaraNvv. Acromegaly quality of life questionnaire (AcroQoL). Health Qual Life Outcomes. 2004; 2: 13.
24.
BohannonRW, PeolssonA, Massy-WestroppN, DesrosiersJ, Bear-LehmanJ. Reference values for adult grip strength measured with a Jamar dynamometer: A descriptive meta-analysis. Physiotherapy. 2006; 92(1): 11-5.
25.
GüntherCM, BürgerA, RickertM, CrispinA, SchluzCU. Grip strength in healthy caucasian adults: reference values. J Hand Surg Am. 2008; 33(4): 558-65.
26.
SoleG, HamrénJ, MilosavljevicS, NicholsonH, SullivanSJ. Test-retest reliability of isokinetic knee extension and flexion. Arch Phys Med Rehabil. 2007; 88(5): 626-31.
27.
SantosML, GomesWF, PereiraDS, OliveiraDM, DiasJM, FerrioliE, et al. Muscle strength, muscle balance, physical function and plasma interleukin-6 (IL-6) levels in elderly women with knee osteoarthritis (OA). Arch Gerontol Geriatr. 2011; 52(3): 322-6.
28.
LautamiesR, HarilainenA, KettunenJ, SandelinJ, KujalaUM. Isokinetic quadriceps and hamstring muscle strength and knee function 5 years after anterior cruciate ligament reconstruction: comparison between bone-patellar tendon-bone and hamstring tendon autografts. Knee Surg Sports Traumatol Arthrosc. 2008; 16(11): 1009-16.
29.
DvirZ. Isokinetics: muscle testing, interpretation and clinical applications. 2nd ed. New York: Churchill Livingstone; 2004.
30.
PeixotoJG, DiasJM, DiasRC, da FonsecaST, Teixeira-SalmelaLF. Relationships between measures of muscular performance, proprioceptive acuity, and aging in elderly women with knee osteoarthritis. Arch Gerontol Geriatr. 2011; 53(2): e253-7.
31.
CheungRT, SmithAW, WongDP. H:q ratios and bilateral leg strength in college field and court sports players. J Hum Kinet. 2012; 33: 63-71.
32.
SeymourJM, SpruitMA, HopkinsonNS, NatanekSA, ManWD, JacksonA, et al. The prevalence of quadriceps weakness in COPD and the relationship with disease severity. Eur Respir J. 2010; 36(1): 81-8.
33.
FreedsonPS, GilliamTB, MahoneyT, MaliszewskiAF, KastangoK. Industrial torque levels by age group and gender. Isokinet Exerc Sci. 1993; 3(1): 34-42.
34.
ZigmondAS, SnaithRP. The hospital anxiety and depression scale. Acta Psychiatr Scand. 1983; 67(6): 361-70.
35.
BiermaszNR, van ThielSW, PereiraAM, HoftijzerHC, van HemertAM, SmitJW, et al. Decreased quality of life in patients with acromegaly despite long-term cure of growth hormone excess. J Clin Endocrinol Metab. 2004; 89(11): 5369-76.
36.
WoodhouseLJ, MukherjeeA, ShaletSM, EzzatS. The influence of grown hormone status on physical impairments, functional limitations, and health-related quality of life in adults. Endocr Rev. 2006; 27(3): 287-317.
37.
KannusP. Isokinetic evaluation of muscular performance: implications for muscle testing and rehabilitation. Int J Sports Med. 1994; 15(Suppl 1): 11-8.
38.
MancaA, SolinasG, DragoneD, DvirZ, DeriuF. Characterization of ankle dorsiflexors performance in healthy subjects following maximal-intensity isokinetic resistance training. J EMG Kinesiol. 2015; 25(5): 773-81.
39.
DiasJMD, ArantesPMM, AlencarMA, FariaJC, MachalaCC, CamargosFFO, et al. Relação isquiotibiais/quadríceps em mulheres idosas utilizando o dinamômetro isocinético. Rev Bras Fisioter. 2004; 8(2): 111-5.
40.
GürH, CakinN. Muscle mass, isokinetic torque, and functional capacity in women with osteoarthritis of the knee. Arch Phys Med Rehabil. 2003; 84(10): 1534-41.
41.
SinghMAF. Exercise and aging. Clin Geriatr Med. 2004; 20(2): 201-21.
42.
WhiteC, DixonK, SamuelD, DtokesM. Handgrip and quadriceps muscle endurance testing in young adults. Springerplus. 2013; 2: 451.
43.
BasseyEJ. Longitudinal changes in selected physical capabilities: muscle strength, flexibility and body size. Age Ageing. 1998; 27(Suppl. 3): 12-16.
