Assessment of muscle strength and mobility

Hand grip strength: Hand grip strength of the non-dominant hand was measured using a digital hand dynamometer (TKK5401; Takei Scientific Instruments, Niigata, Japan). The mean value of three measurements was used for analysis.

Two-step test: The two-step test was performed as previously described [36] as a measure of stride length to assess walking ability, muscle strength, balance, and flexibility. The two-step test score was calculated using the following formula: the length of two steps (cm)/height (cm).

Stand-up test: The stand-up test was also performed as previously described [37] as a measure of leg strength when standing up with one or both legs from a specified height of 10, 20, 30, and 40 cm. If the patient could stand without leaning back and maintain a standing posture for 3 s, then the patient was considered as having achieved that height level.

The 25-question geriatric locomotive function scale (GLFS): The 25-question GLFS was employed as described previously 38 and scored with a five-point scale, where a higher score indicated poorer locomotion.