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Impaired grip strength in children with congenital heart disease
  1. Michael Meyer1,2,
  2. Yi Wang1,
  3. Leon Brudy1,2,
  4. Anna-Luisa Häcker2,
  5. Thorsten Schulz1,
  6. Heidi Weberruss1,
  7. Renate Oberhoffer1,2,
  8. Peter Ewert2,
  9. Jan Müller1,2
  1. 1 Institute of Preventive Pediatrics, Technical University of Munich, Munich, Germany
  2. 2 Department of Pediatric Cardiology and Congenital Heart Disease, German Heart Centre Munich, Munich, Germany
  1. Correspondence to Michael Meyer, Institute of Preventive Pediatrics, Technical University of Munich, 80992 Munich, Germany; michael.meyer{at}


Objectives Grip strength is known to be reduced in adults with congenital heart disease (CHD). This study compared grip strength in paediatric patients with CHD with healthy controls and determined a possible association between grip strength and health-related physical fitness (HRPF).

Methods Grip strength and HRPF were assessed in 569 children (12.4 years, 95% CI 12.16 to 12.72; 238 girls) with various CHD and compared with 2551 healthy controls (11.4 years, 95% CI 11.3 to 11.5; 1424 girls). Grip strength was determined as the maximum value of three repetitions with each hand. HRPF was tested by five motor tasks (FITNESSGRAM) and converted into an SD score (z-score).

Results After adjusting for age, sex and weight, children with CHD showed significantly lower grip strength compared with healthy controls (CHD: 20.8 kg, 95% CI 20.4 to 21.2; controls: 24.5 kg, 95% CI 24.3 to 24.8). CHD subgroup analysis also revealed significantly lower grip strength than the controls, with the lowest values in patients with total cavopulmonary connection (19.1, 95% CI 18.0 to 20.2). Children with complex CHD showed the lowest values with 19.8 kg (95% CI 19.2 to 20.4), those with moderate 20.7 kg (95% CI 19.9 to 21.4) and those with simple 22.5 kg (95% CI 21.6 to 23.3), respectively. HRPF was also lower (z-score: −0.46, 95% CI −0.49 to –0.35) compared with healthy controls and poorly associated with grip strength (r=0.21).

Conclusions Grip strength is already reduced in children with CHD and poorly associated with HRPF. This suggests that grip strength and HRPF are different domains and have to be assessed separately.

  • cardiology
  • rehabilitation
  • growth

Data availability statement

No data are available. All data relevant to the study are included in the article. Data may be available from the corresponding author on reasonable request only.

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Data availability statement

No data are available. All data relevant to the study are included in the article. Data may be available from the corresponding author on reasonable request only.

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  • Correction notice This paper has been corrected since it was first published. There was a typographical error in the results section of the abstract. 19.19.8 kg has been corrected to 19.8 kg.

  • Contributors JM was responsible for conception and design of the study and for data monitoring and integrity. LB, A-LH and MM sampled the data at the study centre. HW and TS were responsible for data sampling of the healthy control group in the school-based projects. YW and MM analysed the data and MM further drafted the manuscript. RO and PE gave important input for revising and improving the quality of the manuscript. All authors have read and approved the final version of the manuscript.

  • Funding This work was supported by Fördergemeinschaft Kinderherzen eV (grant number W-M-007/2017).

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.