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Trunk Muscle Composition as a Predictor of Reduced Functional Capacity in the Health, Aging and Body Composition Study: The Moderating Role of Back Pain

¹ Department of Physical Therapy and Rehabilitation Science, University of Maryland School of Medicine, Baltimore.
² Clinical Research Branch and ³ Laboratory of Epidemiology, Demography and Biometry, National Institute on Aging, Baltimore, Maryland.
⁴ Department of Epidemiology and ⁵ Division of Geriatric Medicine, University of Pittsburgh, Pennsylvania.
⁶ Department of Epidemiology and Biostatistics, University of California at San Francisco.
⁷ Department of Preventive Medicine, University of Tennessee, Memphis.

Address correspondence to Gregory E. Hicks, PhD, PT, Department of Physical Therapy and Rehabilitation Science, University of Maryland School of Medicine, 100 Penn St., Baltimore, MD 21201. E-mail: ghicks{at}som.umaryland.edu

Background. Cross-sectionally, lower trunk muscle attenuation (higher fat infiltration) has been associated with poorer physical function in older adults. We hypothesize that lower trunk muscle attenuation will be associated with lower functional capacity 3 years later and that back pain status will moderate this relationship.

Methods. The study sample consisted of a biracial cohort of well functioning men (739) and women (788) aged 70–79 years from the Pittsburgh site of the Health, Aging and Body Composition (Health ABC) study. Computed tomography was used to measure trunk muscle area and attenuation of the lumbar paraspinal, lateral abdominal, and rectus abdominus muscles at baseline. The Health ABC Physical Performance Battery (usual and narrow walk, chair stands, and standing balance) was used to measure functional capacity at the first and fourth annual clinic visits.

Results. Regardless of back pain status, average trunk muscle attenuation (but not muscle area) was positively associated with overall physical performance, particularly balance (p <.01), in a fully adjusted model. The association between trunk attenuation and functional capacity was significantly stronger in participants with at least moderate back pain in the year prior to baseline (p <.05 for interaction; attenuation x back pain). Participants with moderate to extreme back pain had a greater decline in function over time (p <.05).

Conclusions. Older adults with poorer trunk muscle composition (higher fat infiltration) exhibit reduced functional capacity, especially balance, 3 years later. Improving trunk muscle composition may be an important yet overlooked approach to maintain function and potentially reduce balance impairments, particularly in persons with a history of back pain.