Muscle strength, adiposity, and health-related quality of life in older adults: a cross-sectional study
DOI:
https://doi.org/10.55040/2hmqch29Keywords:
muscle strength;, body composition;, older adults, cross-sectional study, health-related quality of lifeAbstract
Muscle strength is a key factor influencing health-related quality of life (HRQoL) in older adults, yet its relationship with body fat remains understudied. This cross-sectional study examined associations between muscle strength, adiposity, and HRQoL in 253 community-dwelling participants aged 65 years or older from the GMOVE project. Assessments included sociodemographic characteristics, handgrip strength, body composition, and HRQoL measured with the SF-36v2 questionnaire. Linear regression models, adjusted for age, sex, and socioeconomic status, were used to explore the associations. Results showed that higher muscle strength was significantly associated with better HRQoL, independent of body fat levels. Participants with greater strength consistently reported higher HRQoL scores than those with lower strength, regardless of adiposity. These findings highlight the potential importance of maintaining or improving muscle strength to support well-being in older adults. The results suggest that interventions targeting muscle strength may mitigate some negative effects of excess adiposity on HRQoL. Future research should incorporate comprehensive body composition measures, larger samples, and longitudinal designs to clarify causal pathways and inform evidence-based strategies for healthy aging.
References
Agostinis-Sobrinho, C., Rúa-Alonso, M., Vaz, C., Pires, N., Marques, E., Serra, N., & Vila-Chã, C. (2025). Muscle strength and fatness on falls and fear of falling among older adults. Journal of Aging and Physical Activity, 1(aop), 1–6. https://doi.org/10.1123/japa.2024-0146
Alcazar, J., Navarrete-Villanueva, D., Mañas, A., Gómez-Cabello, A., Pedrero-Chamizo, R., Alegre, L. M., Villa, G., Gusi, N., González-Gross, M., & Casajús, J. A. (2021). 'Fat but powerful' paradox: Association of muscle power and adiposity markers with all-cause mortality in older adults from the EXERNET multicentre study. British Journal of Sports Medicine, 55(21), 1204–1211. https://doi.org/10.1136/bjsports-2020-103720
Andersen, L. L., López-Bueno, R., Núñez-Cortés, R., Cadore, E. L., Polo-López, A., & Calatayud, J. (2024). Association of muscle strength with all-cause mortality in the oldest old: Prospective cohort study from 28 countries. Journal of Cachexia, Sarcopenia and Muscle, 15(6), 2756–2764. https://doi.org/10.1002/jcsm.13619
Bastos, R. S., Sa, L. M., Velasco, S. R. M., Teixeira, D. F., Paino, L. S., & Vettore, M. V. (2021). Frailty and oral health-related quality of life in community-dwelling older adults: A cross-sectional study. Brazilian Oral Research, 35, e139. https://doi.org/10.1590/1807-3107bor-2021.vol35.0139
Bosello, O., & Vanzo, A. (2021). Obesity paradox and aging. Eating and Weight Disorders - Studies on Anorexia, Bulimia and Obesity, 26, 27–35. https://doi.org/10.1007/s40519-019-00815-4
Chagas, C. S., Ohara, D. G., Matos, A. P., Oliveira, M. S. R. D., Lopes, M. G. R., Marmo, F. A. D., ... & Pegorari, M. S. (2021). Association between sarcopenia and health-related quality of life in community-dwelling older adults. Acta Paulista de Enfermagem, 34, eAPE002125. https://doi.org/10.37689/acta-ape/2021AO002125
da Costa Pereira, J. P., Freire, Y. A., da Silva, A. M. B., de Lucena Alves, C. P., de Melo Silva, R., Câmara, M., ... & Trussardi Fayh, A. P. (2024). Associations of upper- and lower-limb muscle strength, mass, and quality with health-related quality of life in community-dwelling older adults. Geriatrics & Gerontology International, 24(7), 683–692. https://doi.org/10.1111/ggi.14912
de Souza Moreira, B., de Souza Andrade, A. C., Lustosa Torres, J., de Souza Braga, L., de Carvalho Bastone, A., de Melo Mambrini, J. V., & Lima-Costa, M. F. (2022). Nationwide handgrip strength values and factors associated with muscle weakness in older adults: Findings from the Brazilian Longitudinal Study of Aging (ELSI-Brazil). BMC Geriatrics, 22(1), 1005. https://doi.org/10.1186/s12877-022-03721-0
Donini, L. M., Pinto, A., Giusti, A. M., Lenzi, A., & Poggiogalle, E. (2020). Obesity or BMI paradox? Beneath the tip of the iceberg. Frontiers in Nutrition, 7, 53. https://doi.org/10.3389/fnut.2020.00053
Fang, W. H., Yang, J. R., Lin, C. Y., Hsiao, P. J., Tu, M. Y., Chen, C. F., ... & Su, S. L. (2020). Accuracy augmentation of body composition measurement by bioelectrical impedance analyzer in elderly population. Medicine, 99(7), e19103. https://doi.org/10.1097/md.0000000000019103
Fernandes, D. (2007). A avaliação das aprendizagens no Sistema Educativo Português. Educação e Pesquisa, 33, 581-600. https://doi.org/10.1590/S1517-97022007000300013
García-Hermoso, A., Cavero-Redondo, I., Ramírez-Vélez, R., Ruiz, J., Ortega, F. B., Lee, D.-C., & Martínez-Vizcaíno, V. (2018). Muscular strength as a predictor of all-cause mortality in apparently healthy population: A systematic review and meta-analysis of data from approximately 2 million men and women. Archives of Physical Medicine and Rehabilitation. https://doi.org/10.1016/j.apmr.2018.01.008
Gill, D. L., Hammond, C. C., Reifsteck, E. J., Jehu, C. M., Williams, R. A., Adams, M. M., Lange, E. H., Becofsky, K., Rodriguez, E., & Shang, Y.-T. (2013). Physical activity and quality of life. Journal of Preventive Medicine and Public Health, 46(Suppl 1), S28. https://doi.org/10.3961/jpmph.2013.46.S.S28
Gravina, G., Ferrari, F., & Nebbiai, G. (2021). The obesity paradox and diabetes. Eating and Weight Disorders - Studies on Anorexia, Bulimia and Obesity, 26, 1057–1068. https://doi.org/10.1007/s40519-020-01015-1
Gruberg, L., Weissman, N. J., Waksman, R., Fuchs, S., Deible, R., Pinnow, E. E., ... & Lindsay, J. (2002). The impact of obesity on the short-term and long-term outcomes after percutaneous coronary intervention: The obesity paradox? Journal of the American College of Cardiology, 39(4), 578–584. https://doi.org/10.1016/S0735-1097(01)01802-2
Harman, D. (1981). The aging process. Proceedings of the National Academy of Sciences, 78(11), 7124–7128. https://doi.org/10.1073/pnas.78.11.7124
Haynes, E. M. K., Neubauer, N. A., Cornett, K. M. D., O'Connor, B. P., Jones, G. R., & Jakobi, J. M. (2020). Age and sex-related decline of muscle strength across the adult lifespan: A scoping review of aggregated data. Applied Physiology, Nutrition, and Metabolism, 45(11), 1185–1196. https://doi.org/10.1139/apnm-2020-0081
Herrera, M. S., Elgueta, R., Fernández, M. B., Giacoman, C., Leal, D., Marshall, P., ... & Bustamante, F. (2021). A longitudinal study monitoring the quality of life in a national cohort of older adults in Chile before and during the COVID-19 outbreak. BMC Geriatrics, 21(1), 143. https://doi.org/10.1186/s12877-021-02110-3
Horwich, T. B., Fonarow, G. C., & Clark, A. L. (2018). Obesity and the obesity paradox in heart failure. Progress in Cardiovascular Diseases, 61(2), 151–156. https://doi.org/10.1016/j.pcad.2018.05.005
Kalantar-Zadeh, K., Block, G., Horwich, T., & Fonarow, G. C. (2004). Reverse epidemiology of conventional cardiovascular risk factors in patients with chronic heart failure. Journal of the American College of Cardiology, 43(8), 1439–1444. https://doi.org/10.1016/j.jacc.2003.11.039
Kanaya, A. M., Lindquist, K., Harris, T. B., Launer, L., Rosano, C., Satterfield, S., & Yaffe, K. (2009). Total and regional adiposity and cognitive change in older adults: The Health, Aging and Body Composition (ABC) study. Archives of Neurology, 66(3), 329–335. https://doi.org/10.1001/archneurol.2008.570
Khodadad Kashi, S., Mirzazadeh, Z. S., & Saatchian, V. (2023). A systematic review and meta-analysis of resistance training on quality of life, depression, muscle strength, and functional exercise capacity in older adults aged 60 years or more. Biological Research for Nursing, 25(1), 88–106. https://doi.org/10.1177/10998004221120945
Koen, J. D., & Yonelinas, A. P. (2014). The effects of healthy aging, amnestic mild cognitive impairment, and Alzheimer's disease on recollection and familiarity: A meta-analytic review. Neuropsychology Review, 24, 332–354. https://doi.org/10.1007/s11065-014-9266-5
Liu, C., Wong, P. Y., Chung, Y. L., Chow, S. K., Cheung, W. H., Law, S. W., Chan, J. C. N., & Wong, R. M. Y. (2023). Deciphering the "obesity paradox" in the elderly: A systematic review and meta-analysis of sarcopenic obesity. Obesity Reviews, 24(2), e13534. https://doi.org/10.1111/obr.13534
Medicine, American College of Sports. (2013). ACSM's guidelines for exercise testing and prescription. Lippincott Williams & Wilkins.
Mikkola, T. M., Kautiainen, H., von Bonsdorff, M. B., Salonen, M. K., Wasenius, N., Kajantie, E., & Eriksson, J. G. (2020). Body composition and changes in health-related quality of life in older age: A 10-year follow-up of the Helsinki Birth Cohort Study. Quality of Life Research, 29, 2039–2050. https://doi.org/10.1007/s11136-020-02453-1
Neeland, I. J., Poirier, P., & Després, J.-P. (2018). Cardiovascular and metabolic heterogeneity of obesity: Clinical challenges and implications for management. Circulation, 137(13), 1391–1406. https://doi.org/10.1161/circulationaha.117.029617
Perri, G., French, C., Agostinis-Sobrinho, C., Anand, A., Antarianto, R. D., Arai, Y., Baur, J. A., Cauli, O., Clivaz-Duc, M., & Colloca, G. (2025). An expert consensus statement on biomarkers of aging for use in intervention studies. The Journals of Gerontology, Series A: Biological Sciences and Medical Sciences, 80(5), glae297. https://doi.org/10.1093/gerona/glae297
Qin, Y., Hao, X., Lv, M., Zhao, X., Wu, S., & Li, K. (2023). A global perspective on risk factors for frailty in community-dwelling older adults: A systematic review and meta-analysis. Archives of Gerontology and Geriatrics, 105, 104844. https://doi.org/10.1016/j.archger.2022.104844
Ravindran, S. G., Saha, D., Iqbal, I., Jhaveri, S., Avanthika, C., Naagendran, M. S., Bethineedi, L. D., Santhosh, T., Ravindran, S. G., & Sree Naagendran, M. (2022). The obesity paradox in chronic heart disease and chronic obstructive pulmonary disease. Cureus, 14(6). https://doi.org/10.7759/cureus.25674
Reid, K. F., Pasha, E., Doros, G., Clark, D. J., Patten, C., Phillips, E. M., Frontera, W. R., & Fielding, R. A. (2014). Longitudinal decline of lower extremity muscle power in healthy and mobility-limited older adults: Influence of muscle mass, strength, composition, neuromuscular activation and single fiber contractile properties. European Journal of Applied Physiology, 114, 29–39. https://doi.org/10.1007/s00421-013-2728-2
Santo, R. C. E., Melo, G. R., Dubey, V. P., Razbadauskas, A., & Agostinis-Sobrinho, C. A. (2025). Health outcomes and healthcare utilization among older adults based on weight status and muscle strength: Insights from 27 European countries. Archives of Gerontology and Geriatrics, 105940. https://doi.org/10.1016/j.archger.2025.105940
Sillanpää, E., Cheng, S., Häkkinen, K., Finni, T., Walker, S., Pesola, A., ... & Sipilä, S. (2014). Body composition in 18-to 88-year-old adults—comparison of multifrequency bioimpedance and dual-energy X-ray absorptiometry. Obesity, 22(1), 101–109. https://doi.org/10.1002/oby.20583
Wei, L., Hu, Y., Tao, Y., Hu, R., & Zhang, L. (2022). The effects of physical exercise on the quality of life of healthy older adults in China: A systematic review. Frontiers in Psychology, 13, 895373. https://doi.org/10.3389/fpsyg.2022.895373
Yang, S., Li, T., Yang, H., Wang, J., Liu, M., Wang, S., ... & Jiang, B. (2020). Association between muscle strength and health-related quality of life in a Chinese rural elderly population: A cross-sectional study. BMJ Open, 10(1), e026560. https://doi.org/10.1136/bmjopen-2018-026560
Yaya, S., Idriss-Wheeler, D., Sanogo, N. D. A., Vezina, M., & Bishwajit, G. (2020). Self-reported activities of daily living, health and quality of life among older adults in South Africa and Uganda: A cross-sectional study. BMC Geriatrics, 20(1), 402. https://doi.org/10.1186/s12877-020-01809-z
Downloads
Published
Issue
Section
License
Copyright (c) 2026 César Aparecido Agostinis-Sobrinho, Ana Raquel Costa-Brito, Cláudia Vaz, Ermelinda Marques, Nuno Serra, Carolina Vila-Chã (Autor/a)

This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
The works published in this journal are subject to the following terms:
The author retains the economic rights (copyright) of the published works and grants the journal the right of first publication.
The works are published in the electronic edition of the journal under a Creative Commons Attribution–NonCommercial–ShareAlike license. They may be copied, used, distributed, transmitted, and publicly displayed, provided that: (i) authorship and the original source of publication (journal, publisher, and URL of the work) are cited; (ii) they are not used for commercial purposes; (iii) the existence and specifications of this license are indicated.
![]()
Self-archiving conditions. Authors are permitted and encouraged to disseminate electronically the post-print versions (publisher’s version), as this facilitates earlier circulation and dissemination, potentially increasing citation and reach within the academic community. Authors may also deposit their articles in repositories and other platforms that support the dissemination of information, provided that the version used is the post-print (publisher’s version). RoMEO color: Blue.