Muscle Mass, Strength, and Power as Predictors of Falls among Active Community-Dwelling Older Adults

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Abstract
Background/Objectives: Falls are a leading cause of morbidity and mortality in older adults, even among those who are physically active. This study examined the associations of skeletal muscle mass, muscle strength, and muscle power with fall risk in community-dwelling, physically active older adults. Methods: A cross-sectional analysis was conducted with 280 participants (71.9 ± 5.3 years; 75% women) enrolled in the Stay Up–Falls Prevention Project. Assessments included skeletal muscle mass (anthropometric prediction equation), handgrip strength, lower-limb strength and power (Five Times Sit-to-Stand test, 5xSTS), and fall history over the past 12 months. Muscle power was calculated from 5xSTS performance using the equation proposed by Alcazar and colleagues. Logistic regression models and receiver operating characteristic (ROC) curve analyses were performed. Results: Overall, 26.4% of participants reported at least one fall in the previous year, with a higher prevalence among women (28.9%) than men (18.8%). Fallers showed significantly lower handgrip strength (23.1 vs. 25.4 kg, p = 0.022) and poorer lower-limb strength (9.2 vs. 8.7 s, p = 0.007) compared with non-fallers. However, no significant differences were found for skeletal muscle mass or sit-to-stand–derived power. In multivariable models adjusted for age, sex, body mass index, comorbidities, and medications, lower-limb strength remained the only independent predictor of falls (OR = 1.78, 95% CI: 1.11–2.85, p = 0.016). ROC analysis confirmed fair discriminative capacity for 5xSTS performance (AUC = 0.616, p = 0.003), with an optimal cut-off of 8.62 s (sensitivity = 78.4%, specificity = 33.0%). Handgrip strength, muscle mass, and power did not show independent predictive value. Conclusions: These findings indicate that the 5xSTS test provides a simple, cost-effective, and clinically relevant measure for fall-risk screening in active older adults. Clinicians should consider the 5xSTS as a sensitive first-line screening tool, ideally combined with complementary assessments (e.g., balance, gait, cognition) to improve risk stratification and guide preventive interventions in ageing populations.
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