Grip Strength as a Surrogate Measure of Strength, Functional, and Metabolic Parameter Increases in Breast Cancer Survivors Undergoing an Exercise Regimen

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Champ, Chris Peluso, Christie Hilton, Jared Rosenberg, and 3 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5822657/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 06 May, 2025 Read the published version in Scientific Reports → Version 1 posted 8 You are reading this latest preprint version Abstract Grip strength, a surrogate for quantifying strength, correlates with function and longevity. However, this relationship is less clear in women with breast cancer. 138 women undergoing oncologic treatment for breast cancer were enrolled across three institutional review board-approved protocols with three months of resistance training with pre and post assessment of body composition, phase angle, functional movement screen (FMS), balance, weight lifted (load), quality of life, activity levels, and hand grip strength. Significant increases in maximum, minimum, and mean grip strength were seen. Mean grip strength increased by 12.6% and 3.5 kg. Right/left (R/L) mismatch significantly decreased from baseline to post-intervention (13.3 to 8.7%). On univariable analysis, greater baseline mean grip strength was associated with younger age, greater baseline FMS, composite load lifted, activity levels, and decreased R/L balance mismatch. On multivariable analysis, greater mean grip strength was independently associated with greater baseline mobility and composite load lifted. Baseline mean grip strength was associated with baseline lower bodyfat percentage and greater muscle mass, whole body phase angle, and resting metabolic rate (all significant on multivariable analysis, R 2 = 0.247). Grip strength may be a valuable surrogate biomarker within breast cancer survivorship care, particularly in resource-limited settings. Biological sciences/Cancer/Breast cancer Health sciences/Health care/Disease prevention/Lifestyle modification Grip strength breast cancer resistance training exercise science body composition INTRODUCTION Handgrip strength is a practical and readily available biomarker associated with strength, functional status, prognosis, and overall health across a range of patient populations. 1 Among older adults, each standard deviation increase in grip strength is associated with a 5.8% reduction in all-cause mortality. 2 However, it is rarely used in oncologic clinical practice to assess performance status or tolerance of treatment, despite the high risks of fragility and sarcopenia from both cancer diagnoses and treatment. As the relative mortality rates for patients with early-stage breast cancer now approximate those for population-matched controls, functional status and overall health are increasingly relevant to breast cancer survivorship care. 3 A safe, easy, and cost-effective method to measure functional status in the clinic during and after treatment is needed to help monitor patients and minimize morbidity and mortality. Among breast cancer survivors, greater grip strength is significantly associated with superior overall mortality and health-related quality of life, while absolute grip strength is inversely related to risk of developing breast cancer (HR 0.93, HR 0.91–0.96, p = 0.03). 4–7 Such findings are of particular concern given the associations of surgery, radiation therapy, chemotherapy, and hormone therapy to sarcopenia and decreased quality of life. 8 – 10 The emerging field of exercise oncology seeks to optimize oncologic outcomes and quality of life through exercise regimens designed to optimize strength, metabolic, and functional parameters. A growing body of data suggest that principles of hypertrophy established in non-oncologic populations are both safe and effective in breast cancer survivors, including high-intensity dose escalated resistance training that utilizes compound movements across a range of functional movement patterns. 11 – 13 However, noninvasive and cost-effective methods to track physical improvement remain limited, particularly in the breast cancer setting. We hypothesize that, among breast cancer survivors, grip strength is a useful surrogate for quantifying improvements in strength and functional status that may correlate to metabolic parameters. Particularly in resource-limited settings, grip strength may serve as a valuable surrogate biomarker for longitudinal assessment within emerging exercise oncology programs. Thus, this work analyzes the results of three clinical trials assessing grip strength changes from intense resistance training in a population of women undergoing treatment for breast cancer. METHODS Participants Women undergoing oncologic treatment for breast cancer were enrolled across three institutional review board-approved (Allegheny Health Network Institutional Review Board) protocols registered at cliicaltrials.gov (NCT05747209, NCT05978960, and NCT06083324. Informed consent was obtained from all subjects, and all research was performed in accordance with relevant guidelines/regulations, and in accordance with the Declaration of Helsinki. While inclusion criteria varied slightly across these trials, all participants were women >18 years old receiving some combination of oncologic surgery (mastectomy or lumpectomy) with or without axillary sentinel lymph node biopsy, axillary lymph node dissection, anti-estrogen therapy, cytotoxic chemotherapy, and/or radiation therapy. Inclusion criteria included women aged 20-95 years old diagnosed with breast cancer and able to get up and down from the floor and squat their body weight. Exclusion criteria included the inability to engage in group exercise, pregnancy, and severe arthritic or cardiovascular conditions deemed unsafe to engage in resistance training. Individuals on chemotherapy were excluded from two of the studies. Exercise regimen All participants completed a three-month resistance training exercise regimen under the direct supervision of dually certified MD and Certified Strength and Conditioning Specialist personnel, previously described in detail. 11,14 In brief, all participants were screened for safety with respect to medical comorbidities and baseline functional mobility including the ability to perform basic functional mobility patterns. The resistance training program, derived from evidence-based principles for optimal induction of hypertrophy, 15–17 emphasized dose escalation of high-intensity compound exercises across four primary movement patterns: split squat, trap bar deadlifts, incline dumbbell bench press, and bird dog row. To avoid overestimating increases in load lifted from initial neuromuscular adaptation to novel stimuli, baseline measurements in load lifted (pounds x repetitions x sets) were performed following the first month of the exercise regimen. Total load lifted was then remeasured at completion of month 3, with compound load lifted calculated as the sum of load across all four compound exercises. Anthropometric, metabolic, and functional parameters Baseline and post-regimen assessment included current exercise adherence, body composition, quality of life, balance, and mobility. Body composition parameters (i.e., percent body fat and muscle mass; bone mineral content [g/cm]), whole body phase angle (degrees), and resting metabolic rate (calories/day) were measured with bioimpedance analysis. Balance was measured via the Y-balance test, functional mobility via the Functional Movement Screen (FMS), and patient-reported quality of life via the Godin Leisure-Time Exercise Questionnaires. Further details on these methods are previously reported. 11 Grip Strength Grip strength was measured using a Jamar Hand Dynamometer device. Participants were instructed to sit comfortably while holding the forearm in a neutral position and elbow bent at a 90-degree angle consistent with the American Society of Hand Therapists guidelines. 18 In this position, participants were encouraged to squeeze the dynamometer as hard as possible in each hand. The highest of 3 measurements was recorded at each timepoint for each hand. Statistical analysis included the following grip strength parameters: maximum right/left (R/L) value across both left and right measurements (kg), minimum R/L value (kg), mean R/L value (kg), and percent R/L mismatch, calculated as the absolute difference in R/L values divided by the R/L mean. Statistical Analysis All anthropometric, metabolic, functional, and quality of life parameters were analyzed as continuous variables. Pairwise comparison was assessed via the paired t test. Multivariable linear regression was performed for all non-collinear parameters demonstrating significant correlation on univariable linear regression with a = 0.05. No data were missing for hand grip strength, demographic, anthropometric, functional or metabolic parameters. Given the rarity of missing quality of life data (2 instances), participants with missing data were excluded from analysis. All statistical analyses were performed using R version 4.1.2 (R Project for Statistical Computing). RESULTS 138 participants completed a three-month resistance training regimen under the direct supervision of dually certified MD, CSCS personnel. Patient demographics, pre-intervention body composition, and cancer treatments are provided in Table 1 . Median age at enrollment was 54.5 years (interquartile range [IQR], 46.3 – 64.0 years) with a median BMI of 28.9 kg/m 2 (IQR 24.4 – 33.1 kg/m 2 ). A majority of participants (84%) had stage 0-2 breast cancer, with 56.5% of participants undergoing lumpectomy and 82.6% completing sentinel lymph node biopsy alone (82.6%) rather than axillary lymph node dissection. Receipt of anti-estrogen therapy was documented in 70.3%, cytotoxic chemotherapy in 16.7%, and radiation therapy in 80.4%. Regarding Jamar dynamometer grip strength ( Table 2 ), significant baseline to post-intervention pair-wise increases were observed for R/L maximum ([median 24 kg, IQR 20 – 28 kg] to [27 kg, IQR 24 – 30 kg]), R/L minimum ([20 kg, IQR 16 – 24 kg] to [24 kg, IQR 20 – 27 kg]), and R/L mean ([22.5 kg, IQR 17.6 – 26.0 kg] to [26.0 kg, IQR 22.1 – 28.4 kg) values (all p < 0.001). Across all participants, R/L mean grip strength increased by a mean of 12.6% (IQR 1.8 – 31.5% increase), resulting in an absolute mean improvement of 3.5 kg (IQR 2.4 - 4.5 kg). R/L percent mismatch in grip strength significantly decreased from baseline (13.3%, IQR 6.5 – 25.8%) to post-intervention (8.7%, IQR 3.9 – 15.4%; p < 0.001). As seen in Supplemental Table 1 , pair-wise comparison of pre- and post-intervention metabolic parameters demonstrated significant decreases in BMI and body fat percentage, as well as significant increases in muscle mass percentage, whole body phase angle, and resting metabolic rate. As seen in Supplemental Table 2 , while the limited distribution of pre- and post-intervention values precluded formal statistical analysis of parameters scored on a Likert scale, Godin Leisure-Time Exercise and Euro-QoL Group EQ-5D responses assessed on a continuous scale uniformly showed significant increases in patient-reported quality of life. Table 3 summarizes linear regression models for parameters associated with baseline R/L mean grip strength. On univariable analysis, greater baseline R/L mean grip strength was significantly associated with younger age (R 2 = 0.116, p<0.001), greater baseline Y-balance (R 2 = 0.116, p<0.001), decreased baseline Y-balance R/L mismatch (R 2 = 0.060, p = 0.004), greater FMS baseline (R 2 = 0.227, p<0.001), greater baseline composite load lifted across compound exercises (R 2 = 0.316, p<0.001), and baseline Godin questionnaire scores (R 2 = 0.083, p<0.001). On multivariable analysis, greater R/L mean grip strength was independently associated with greater baseline FMS (p = 0.032) and greater baseline composite load lifted (p<0.001; model R 2 = 0.360). Table 4 reports grip strength with respect to metabolic parameters. Baseline R/L mean grip strength was associated with lower baseline bodyfat percentage (R 2 = 0.057, p = 0.005), greater baseline muscle mass percentage (R 2 = 0.065, p = 0.002), greater whole body phase angle (R 2 = 0.183, p<0.001), and greater resting metabolic rate (R 2 = 0.057, p = 0.003). These correlations all remained statistically significant on multivariable analysis (model R 2 = 0.247), while excluding bodyfat percentage due to collinearity with muscle mass percentage. Baseline R/L grip strength mismatch demonstrated no association with metabolic parameters. Table 5 provides univariable and multivariable linear regression models exploring parameters associated with pre- to post-intervention percent improvement in R/L mean grip strength. On univariable analysis, significant correlation to greater R/L mean grip strength improvement was observed across the following parameters: lower baseline FMS (R 2 = 0.151, p<0.001), lower baseline composite load lifted (R 2 = 0.086, p<0.001), and lower baseline Godin score, without significant correlation to pre/post-regimen improvements across the same parameters. Absolute improvement in pre- to post-regimen Godin scores were not significantly associated with improvements in mean R/L grip strength. Multivariable analysis of treatment and functional parameters demonstrated no significant correlation to percent improvement in R/L mean grip strength with a trend toward greater baseline composite load lifted (p = 0.06). DISCUSSION Significant increases in grip strength were observed across breast cancer survivors completing a three-month, dose-escalated resistance training regimen employing high-intensity compound exercises. In line with the well-established utilization of grip strength as a simple and practical surrogate for strength and functional status, baseline grip strength was independently associated with greater baseline FMS and composite load lifted across compound exercises. As presently seen and previously reported, these increases in grip strength were observed alongside corresponding improvements in body composition, functional mobility, and quality of life. 11 These data may lend support for utilization of grip strength as a simple and practical surrogate parameter within breast cancer survivorship care. Among breast cancer patients at baseline, the present data demonstrate that greater baseline grip strength correlates not only to generalized muscular strength and functional parameters, but also to a range of favorable baseline metabolic parameters (muscle mass, phase angle, and resting metabolic rate). 19 – 22 In the present data, such correlations in functional and metabolic parameters appear to be stronger than those of grip strength to oncologic treatment parameters. Aside from cytotoxic chemotherapy, oncologic treatments including surgical management of the breast and axilla, anti-estrogen therapy, and radiation therapy did not significantly correlate with baseline grip strength. Independent of exercise and strength goals, these data inform the use and interpretation of grip strength as a biomarker among breast cancer survivors. Given the well-defined association of grip strength to long-term mobility and quality of life, related improvements in grip strength, general muscular strength, and functional mobility are of prime importance. 23 Moreover, while relative survival rates for women with early stage disease approximate those of the general population, 3 breast cancer patients are at high risk for obesity, sarcopenia, and decreased quality of life from systemic, surgical, and radiation therapies. 8 , 9 In this high-risk population, the present data, while not randomized against a control group, may suggest that a high intensity exercise regimen may lead to significant improvements in strength and functional status which are quantifiable through the surrogate biomarker of grip strength. Notably, improvement in grip strength showed stronger association to baseline values rather than the magnitude of pre- to post-regimen improvement across strength, balance, and functional mobility parameters. Regarding quality of life, greater baseline grip strength was significantly associated with higher Godin scores, while improvements in hand grip strength were significantly associated with higher baseline Godin scores though not with greater improvements in pre- to post-regimen Godin scores. These findings may support the importance of strength training as a prophylactic measure in the general population, particularly among those of young and middle age. Although meta-analysis suggests 5.0 kg as a clinically meaningful difference in grip strength, 22 the present mean pre- to post-regimen improvement in grip strength of 3.5 kg (IQR 2.4–4.5 kg) is better interpreted as a surrogate measure in their direct clinical context of related improvements across strength, functional, metabolic, and quality of life parameters. The present study has several limitations. While the reported median BMI of 29 is slightly above the median value for American women 50–70 years old, participants who engage in exercise studies may nevertheless be more motivated to exercise than the general population. 24 The small number of patients across a number of prospective trial protocols may limit the ability to detect small but clinically meaningful associations in grip strength across oncologic treatment parameters as seen in other reports. 10 Limited longitudinal data address the utilization of grip strength across breast cancer survivors, regardless of adherence to an exercise regimen. Future studies should analyze correlation of grip strength to clinical and oncologic outcomes in the presence versus absence of an accompanying exercise regimen. Additionally, the majority of patients had stage I or II breast cancer, so the generalizability across more advanced disease may be limited. That being said, 44% of patients did undergo mastectomy as part of their treatment. Lastly, though changes were similar across the studies and the exercise regimen was the same, varying nutritional intakes of participants during the protocols may have impacted the results and is a confounding factor. In conclusion, among breast cancer survivors, grip strength correlates significantly with favorable increases across strength, functional, and metabolic parameters. Improvements in grip strength were associated with baseline values rather than pre- to post-regimen improvements across strength, balance, and functional mobility parameters. While the present authors would advocate for direct and longitudinal measurement of functional, metabolic, and strength parameters as a gold standard within the emerging field of exercise oncology, grip strength may be a valuable surrogate biomarker within breast cancer survivorship care, particularly in resource-limited settings. Declarations Data Availability: The datasets generated and/or analyzed during the current study are not publicly available due to ongoing analysis and manuscript creation but are available from the corresponding author on reasonable request. Conflicts of Interest: CEC receives income from books and lectures pertaining to nutrition and exercise and is on the scientific advisory board for Simply Good Foods. DJC, CP, JR, AKD, RK, and CH declare no conflict of interest. Funding sources: None Author contributions: DJC, CP, JR, AKD, CEC: Design, data analysis, manuscript drafting, revision, and final approval. CH and RK: Data analysis, manuscript drafting, revision, and final approval. References López-Bueno, R. et al. Associations of handgrip strength with all-cause and cancer mortality in older adults: a prospective cohort study in 28 countries. Age Ageing 51 , 1–11 (2022). Wang, Y. et al. 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Abbreviations: IQR, interquartile range; BMI, body mass index; BMC, bone mineral content; RMR, resting metabolic rate; DCIS, ductal carcinoma in situ; AHT, anti-hormonal therapy; CHT, chemotherapy; RT, radiation therapy; SLNB, sentinel lymph node biopsy; ALND, axillary lymph node dissection Median IQR Age, years 54.5 46.3 - 64.0 Body mass index, kg/m 2 28.9 24.4 - 33.1 Bodyfat percentage 27.8 33.5 - 43.3 Muscle mass percentage 33.6 30.8 - 36.5 Bone mineral content, g/cm 3 6.1 5.6 - 6.6 Phase angle, degrees 5.0 4.6 - 5.2 Resting metabolic rate, calories/day 1370 1268 - 1449 N % Exercise at time of enrollment 56 40.6 Stage 0; Ductal Carcinoma In Situ 12 8.7 I 75 54.3 II 29 21 III 14 10.1 IV 8 5.8 Receipt of anti-estrogen therapy 97 70.3 Receipt of cytotoxic chemotherapy 23 16.7 Receipt of radiation therapy 111 80.4 Receipt of mastectomy 60 43.5 Axillary management Sentinel lymph node biopsy 114 82.6 Axillary lymph node dissection 20 14.5 Table 2: Grip strength, functional, and strength parameters at baseline and at post-intervention. Baseline Post-Intervention Grip parameters Median (IQR) Paired p value R/L Maximum 24 (20-28) 27 (24-30) <0.001 R/L Minimum 20 (16-24) 24 (20-27) <0.001 R/L Mean 22.5 (17.6-26.0) 26.0 (22.1-28.4) <0.001 R/L Mismatch, % 13.3 (6.5 - 25.8) 8.7 (3.9 - 15.4) <0.001 Non-grip parameters Y balance, L/R Mean 77.0 (66.5-85.0) 86.8 (79.4-95.8) <0.001 Y balance, % Mismatch 3.8 (1.4-8.1) 3.4 (1.7-6.0) 0.010 Functional mobility screen score 10 (9-12) 13 (10-15) <0.001 Composite Load 4129 (3361-5161) 6162 (4854-7315) <0.001 *Pre/post intervention improvement in Grip L/R mean was 12.6% (1.8 - 31.5%) Table 3: Univariate and multivariable linear regression of parameters associated with baseline R/L mean grip strength F value R squared UVA p value MVA p value Age, years 17.8 0.116 <0.001 0.326 Breast cancer stage: II or greater 0.028 0.0002 0.867 - Receipt of anti-estrogen therapy 0.123 0.0009 0.726 - Receipt of cytotoxic chemotherapy 5.735 0.0408 0.018 - Receipt of radiation therapy 3.696 0.0265 0.057 - Receipt of mastectomy 3.221 0.0231 0.075 - Receipt of axillary lymph node dissection 0.036 0.0002 0.85 - Baseline Y-balance mean 38.26 0.22 <0.001 0.467 Baseline Y-balance mismatch 8.65 0.0598 0.004 - Baseline functional mobility screen score 39.83 0.2265 <0.001 0.032 Baseline Composite load 62.67 0.316 <0.001 <0.001 Baseline Godin score 12.3 0.083 <0.001 0.268 Table 4: Univariable and multivariable linear regression with grip strength as the independent variable with respect to metabolic parameters. Grip R/L Mean, Baseline F value R squared UVA p value MVA p value Baseline bodyfat, % 8.147 0.0565 0.005 - Baseline muscle mass, % 9.463 0.0651 0.002 0.004 Baseline whole body phase angle, degrees 31.68 0.183 <0.001 <0.001 Baseline Inbody resting metabolic rate 9.211 0.0566 0.003 0.011 Grip, R/L Mismatch Baseline Baseline bodyfat, % 1.675 0.0122 0.198 - Baseline muscle mass, % 0.6206 0.0045 0.432 - Baseline whole body phase angle, degrees 0.0128 0.00009 0.910 - Baseline Inbody resting metabolic rate 0.6678 0.0049 0.415 - Table 5: Univariate and multivariable linear regression of parameters associated with pre- to post-intervention improvement in R/L mean grip strength F value R squared UVA p MVA p Age, years 2.704 0.195 0.102 - Breast cancer stage, II or greater 0.001 <0.001 0.992 - Receipt of anti-estrogen therapy 0.07 0.005 0.792 - Receipt of cytotoxic chemotherapy 1.409 0.0103 0.237 - Receipt of adjuvant radiation therapy 0.273 0.002 0.602 - Receipt of mastectomy 0.869 0.006 0.353 - Receipt of axillary lymph node dissection 3.231 0.0234 0.074 - Y balance mean, baseline 9.749 0.0669 0.002 0.17 Y balance mean, % improvement 3.743 0.0268 0.055 - Y balance mismatch, baseline 2.207 0.16 0.14 - Y balance mismatch, % improvement 2.498 0.018 0.1163 - Functional mobility screen, baseline 24.16 0.151 <0.001 0.751 Functional mobility screen, absolute improvement 1.904 0.138 0.17 - Composite load baseline 12.75 0.0857 <0.001 0.064 Composite Load, % improvement 0.5982 0.0044 0.441 - Godin baseline 8.329 0.0577 0.004 0.09 Godin pre/post absolute improvement 3.341 0.024 0.069 - Bodyfat percentage, baseline 5.592 0.03243 0.020 - Muscle mass percentage, baseline 8.159 0.04966 0.005 - Whole body phase angle, baseline 8.025 0.04878 0.005 - Baseline Inbody resting metabolic rate, baseline 2.7 0.1226 0.1027 - Additional Declarations Competing interest reported. CEC receives income from books and lectures pertaining to nutrition and exercise and is on the scientific advisory board for Simply Good Foods. DJC, CP, JR, AKD, RK, and CH declare no conflict of interest. Supplementary Files Supplementarygriptables4192025.docx Cite Share Download PDF Status: Published Journal Publication published 06 May, 2025 Read the published version in Scientific Reports → Version 1 posted Editorial decision: Accepted 01 May, 2025 Reviews received at journal 29 Apr, 2025 Reviews received at journal 28 Apr, 2025 Reviewers agreed at journal 27 Apr, 2025 Reviewers agreed at journal 27 Apr, 2025 Reviewers invited by journal 26 Apr, 2025 Submission checks completed at journal 22 Apr, 2025 First submitted to journal 05 Apr, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-5822657","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Article","associatedPublications":[],"authors":[{"id":449238960,"identity":"a849258a-c1db-4546-9f82-6a3743e3b47b","order_by":0,"name":"Colin E. Champ","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA0UlEQVRIiWNgGAWjYFAC5oYDQDIBiBkfMDYQpYURroXZgGgtDFAtbBJEaeFvb2w8XMBgl8c/7eyxip877jDwSx+/gFeLxJmDDYdnMCQXS9zOS7vZe+YZg2RfTgFeLQYSiQ2HeRgOJDbczjG7wdt2mMHgDE8CcVrmA7UU/iVJywagFmaILewHCPuFxyA5cePtvGRp2bbDPJI9PHh1AEOs+fBnngq7xHm3cw9+fNt2WI6fh/0Bfj0Q54EIiOFAkseACC0wxRBAlC2jYBSMglEwggAAv2pLRKxov04AAAAASUVORK5CYII=","orcid":"","institution":"Allegheny Health Network","correspondingAuthor":true,"prefix":"","firstName":"Colin","middleName":"E.","lastName":"Champ","suffix":""},{"id":449238962,"identity":"040dd6ce-1148-46bf-bdd1-0419d6405cfe","order_by":1,"name":"Chris Peluso","email":"","orcid":"","institution":"Allegheny Health Network","correspondingAuthor":false,"prefix":"","firstName":"Chris","middleName":"","lastName":"Peluso","suffix":""},{"id":449238964,"identity":"e8400807-8a2b-40d9-ba80-79a4b4766e55","order_by":2,"name":"Christie Hilton","email":"","orcid":"","institution":"Allegheny Health Network","correspondingAuthor":false,"prefix":"","firstName":"Christie","middleName":"","lastName":"Hilton","suffix":""},{"id":449238966,"identity":"a7ee7041-ab76-4d28-8ca4-ec3a9c8173c2","order_by":3,"name":"Jared Rosenberg","email":"","orcid":"","institution":"State University of New York College at Cortland","correspondingAuthor":false,"prefix":"","firstName":"Jared","middleName":"","lastName":"Rosenberg","suffix":""},{"id":449238967,"identity":"2c9ec957-998b-47cb-b58d-a1e04d8409bc","order_by":4,"name":"Rhyeli Krause","email":"","orcid":"","institution":"Allegheny Health Network","correspondingAuthor":false,"prefix":"","firstName":"Rhyeli","middleName":"","lastName":"Krause","suffix":""},{"id":449238969,"identity":"9341d8b0-0116-4538-8f50-673f168c2a31","order_by":5,"name":"Alexander K. Diaz","email":"","orcid":"","institution":"Murray-Calloway County Hospital","correspondingAuthor":false,"prefix":"","firstName":"Alexander","middleName":"K.","lastName":"Diaz","suffix":""},{"id":449238972,"identity":"a5079ded-7851-4d8f-bbf2-517bb786a52d","order_by":6,"name":"David J. Carpenter","email":"","orcid":"","institution":"WellStar Health System","correspondingAuthor":false,"prefix":"","firstName":"David","middleName":"J.","lastName":"Carpenter","suffix":""}],"badges":[],"createdAt":"2025-01-13 21:23:06","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-5822657/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5822657/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1038/s41598-025-00867-w","type":"published","date":"2025-05-06T15:56:53+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":82537659,"identity":"6f553a8e-3b06-4030-a2f1-95e19c04510b","added_by":"auto","created_at":"2025-05-12 16:09:52","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":814937,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5822657/v1/4c0ea226-ea42-4500-ad27-de588a245645.pdf"},{"id":81624636,"identity":"1196f249-b27a-4928-8255-f090be24e1f0","added_by":"auto","created_at":"2025-04-29 10:02:16","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":16421,"visible":true,"origin":"","legend":"","description":"","filename":"Supplementarygriptables4192025.docx","url":"https://assets-eu.researchsquare.com/files/rs-5822657/v1/6dfada8805be1117b2dd8395.docx"}],"financialInterests":"Competing interest reported. CEC receives income from books and lectures pertaining to nutrition and exercise and is on the scientific advisory board for Simply Good Foods. DJC, CP, JR, AKD, RK, and CH declare no conflict of interest.","formattedTitle":"Grip Strength as a Surrogate Measure of Strength, Functional, and Metabolic Parameter Increases in Breast Cancer Survivors Undergoing an Exercise Regimen","fulltext":[{"header":"INTRODUCTION","content":"\u003cp\u003eHandgrip strength is a practical and readily available biomarker associated with strength, functional status, prognosis, and overall health across a range of patient populations.\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u003c/sup\u003e Among older adults, each standard deviation increase in grip strength is associated with a 5.8% reduction in all-cause mortality.\u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e However, it is rarely used in oncologic clinical practice to assess performance status or tolerance of treatment, despite the high risks of fragility and sarcopenia from both cancer diagnoses and treatment.\u003c/p\u003e \u003cp\u003eAs the relative mortality rates for patients with early-stage breast cancer now approximate those for population-matched controls, functional status and overall health are increasingly relevant to breast cancer survivorship care.\u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e A safe, easy, and cost-effective method to measure functional status in the clinic during and after treatment is needed to help monitor patients and minimize morbidity and mortality. Among breast cancer survivors, greater grip strength is significantly associated with superior overall mortality and health-related quality of life, while absolute grip strength is inversely related to risk of developing breast cancer (HR 0.93, HR 0.91\u0026ndash;0.96, p\u0026thinsp;=\u0026thinsp;0.03).\u003csup\u003e4\u0026ndash;7\u003c/sup\u003e Such findings are of particular concern given the associations of surgery, radiation therapy, chemotherapy, and hormone therapy to sarcopenia and decreased quality of life.\u003csup\u003e\u003cspan additionalcitationids=\"CR9\" citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eThe emerging field of exercise oncology seeks to optimize oncologic outcomes and quality of life through exercise regimens designed to optimize strength, metabolic, and functional parameters. A growing body of data suggest that principles of hypertrophy established in non-oncologic populations are both safe and effective in breast cancer survivors, including high-intensity dose escalated resistance training that utilizes compound movements across a range of functional movement patterns.\u003csup\u003e\u003cspan additionalcitationids=\"CR12\" citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u003c/sup\u003e However, noninvasive and cost-effective methods to track physical improvement remain limited, particularly in the breast cancer setting. We hypothesize that, among breast cancer survivors, grip strength is a useful surrogate for quantifying improvements in strength and functional status that may correlate to metabolic parameters. Particularly in resource-limited settings, grip strength may serve as a valuable surrogate biomarker for longitudinal assessment within emerging exercise oncology programs. Thus, this work analyzes the results of three clinical trials assessing grip strength changes from intense resistance training in a population of women undergoing treatment for breast cancer.\u003c/p\u003e"},{"header":"METHODS","content":"\u003cp\u003e\u003cstrong\u003e\u003cem\u003eParticipants\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWomen undergoing oncologic treatment for breast cancer were enrolled across three institutional review board-approved (Allegheny Health Network Institutional Review Board) protocols registered at cliicaltrials.gov (NCT05747209, NCT05978960, and NCT06083324. Informed consent was obtained from all subjects, and all research was performed in accordance with relevant guidelines/regulations, and in accordance with the Declaration of Helsinki. While inclusion criteria varied slightly across these trials, all participants were women \u0026gt;18 years old receiving some combination of oncologic surgery (mastectomy or lumpectomy) with or without axillary sentinel lymph node biopsy, axillary lymph node dissection, anti-estrogen therapy, cytotoxic chemotherapy, and/or radiation therapy. Inclusion criteria included women aged 20-95 years old diagnosed with breast cancer and able to get up and down from the floor and squat their body weight. Exclusion criteria included the inability to engage in group exercise, pregnancy, and severe arthritic or cardiovascular conditions deemed unsafe to engage in resistance training. Individuals on chemotherapy were excluded from two of the studies.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eExercise regimen\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll participants completed a three-month resistance training exercise regimen under the direct supervision of dually certified MD and Certified Strength and Conditioning Specialist personnel, previously described in detail.\u003csup\u003e11,14\u003c/sup\u003e In brief, all participants were screened for safety with respect to medical comorbidities and baseline functional mobility including the ability to perform basic functional mobility patterns. The resistance training program, derived from evidence-based principles for optimal induction of hypertrophy,\u003csup\u003e15\u0026ndash;17\u003c/sup\u003e emphasized dose escalation of high-intensity compound exercises across four primary movement patterns: split squat, trap bar deadlifts, incline dumbbell bench press, and bird dog row. To avoid overestimating increases in load lifted from initial neuromuscular adaptation to novel stimuli, baseline measurements in load lifted (pounds x repetitions x sets) were performed following the first month of the exercise regimen. Total load lifted was then remeasured at completion of month 3, with compound load lifted calculated as the sum of load across all four compound exercises.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eAnthropometric, metabolic, and functional parameters\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eBaseline and post-regimen assessment included current exercise adherence, body composition, quality of life, balance, and mobility. Body composition parameters (i.e., percent body fat and muscle mass; bone mineral content [g/cm]), whole body phase angle (degrees), and resting metabolic rate (calories/day) were measured with bioimpedance analysis. Balance was measured via the Y-balance test, functional mobility via the Functional Movement Screen (FMS), and patient-reported quality of life via the Godin Leisure-Time Exercise Questionnaires. Further details on these methods are previously reported.\u003csup\u003e11\u003c/sup\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eGrip Strength\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eGrip strength was measured using a Jamar Hand Dynamometer device. Participants were instructed to sit comfortably while holding the forearm in a neutral position and elbow bent at a 90-degree angle consistent with the American Society of Hand Therapists guidelines.\u003csup\u003e18\u003c/sup\u003e In this position, participants were encouraged to squeeze the dynamometer as hard as possible in each hand. The highest of 3 measurements was recorded at each timepoint for each hand. Statistical analysis included the following grip strength parameters: maximum right/left (R/L) value across both left and right measurements (kg), minimum R/L value (kg), mean R/L value (kg), and percent R/L mismatch, calculated as the absolute difference in R/L values divided by the R/L mean. \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eStatistical Analysis\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll anthropometric, metabolic, functional, and quality of life parameters were analyzed as continuous variables. Pairwise comparison was assessed via the paired t test. Multivariable linear regression was performed for all non-collinear parameters demonstrating significant correlation on univariable linear regression with a = 0.05. No data were missing for hand grip strength, demographic, anthropometric, functional or metabolic parameters. Given the rarity of missing quality of life data (2 instances), participants with missing data were excluded from analysis. All statistical analyses were performed using R version 4.1.2 (R Project for Statistical Computing).\u003c/p\u003e"},{"header":"RESULTS","content":"\u003cp\u003e138 participants completed a three-month resistance training regimen under the direct supervision of dually certified MD, CSCS personnel. Patient demographics, pre-intervention body composition, and cancer treatments are provided in \u003cstrong\u003eTable 1\u003c/strong\u003e. Median age at enrollment was 54.5 years (interquartile range [IQR], 46.3 \u0026ndash; 64.0 years) with a median BMI of 28.9 kg/m\u003csup\u003e2\u0026nbsp;\u003c/sup\u003e(IQR 24.4 \u0026ndash; 33.1 kg/m\u003csup\u003e2\u003c/sup\u003e). A majority of participants (84%) had stage 0-2 breast cancer, with 56.5% of participants undergoing lumpectomy and 82.6% completing sentinel lymph node biopsy alone (82.6%) rather than axillary lymph node dissection. Receipt of anti-estrogen therapy was documented in 70.3%, cytotoxic chemotherapy in 16.7%, and radiation therapy in 80.4%. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eRegarding Jamar dynamometer grip strength (\u003cstrong\u003eTable 2\u003c/strong\u003e), significant baseline to post-intervention pair-wise increases were observed for R/L maximum ([median 24 kg, IQR 20 \u0026ndash; 28 kg] to [27 kg, IQR 24 \u0026ndash; 30 kg]), R/L minimum ([20 kg, IQR 16 \u0026ndash; 24 kg] to [24 kg, IQR 20 \u0026ndash; 27 kg]), and R/L mean ([22.5 kg, IQR 17.6 \u0026ndash; 26.0 kg] to [26.0 kg, IQR 22.1 \u0026ndash; 28.4 kg) values (all p \u0026lt; 0.001). Across all participants, R/L mean grip strength increased by a mean of 12.6% (IQR 1.8 \u0026ndash; 31.5% increase), resulting in an absolute mean improvement of 3.5 kg (IQR 2.4 - 4.5 kg). R/L percent mismatch in grip strength significantly decreased from baseline (13.3%, IQR 6.5 \u0026ndash; 25.8%) to post-intervention (8.7%, IQR 3.9 \u0026ndash; 15.4%; p \u0026lt; 0.001). As seen in \u003cstrong\u003eSupplemental Table 1\u003c/strong\u003e, pair-wise comparison of pre- and post-intervention metabolic parameters demonstrated significant decreases in BMI and body fat percentage, as well as significant increases in muscle mass percentage, whole body phase angle, and resting metabolic rate. As seen in \u003cstrong\u003eSupplemental Table 2\u003c/strong\u003e, while the limited distribution of pre- and post-intervention values precluded formal statistical analysis of parameters scored on a Likert scale, Godin Leisure-Time Exercise and Euro-QoL Group EQ-5D responses assessed on a continuous scale uniformly showed significant increases in patient-reported quality of life.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3\u003c/strong\u003e summarizes linear regression models for parameters associated with baseline R/L mean grip strength. On univariable analysis, greater baseline R/L mean grip strength was significantly associated with younger age (R\u003csup\u003e2\u003c/sup\u003e = 0.116, p\u0026lt;0.001), greater baseline Y-balance (R\u003csup\u003e2\u003c/sup\u003e = 0.116, p\u0026lt;0.001), decreased baseline Y-balance R/L mismatch (R\u003csup\u003e2\u003c/sup\u003e = 0.060, p = 0.004), greater FMS baseline (R\u003csup\u003e2\u003c/sup\u003e = 0.227, p\u0026lt;0.001), greater baseline composite load lifted across compound exercises (R\u003csup\u003e2\u003c/sup\u003e = 0.316, p\u0026lt;0.001), and baseline Godin questionnaire scores (R\u003csup\u003e2\u003c/sup\u003e = 0.083, p\u0026lt;0.001). On multivariable analysis, greater R/L mean grip strength was independently associated with greater baseline FMS (p = 0.032) and greater baseline composite load lifted (p\u0026lt;0.001; model R\u003csup\u003e2\u003c/sup\u003e = 0.360). \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 4\u003c/strong\u003e reports grip strength with respect to metabolic parameters. Baseline R/L mean grip strength was associated with lower baseline bodyfat percentage (R\u003csup\u003e2\u003c/sup\u003e = 0.057, p = 0.005), greater baseline muscle mass percentage (R\u003csup\u003e2\u003c/sup\u003e = 0.065, p = 0.002), greater whole body phase angle (R\u003csup\u003e2\u003c/sup\u003e = 0.183, p\u0026lt;0.001), and greater resting metabolic rate (R\u003csup\u003e2\u003c/sup\u003e = 0.057, p = 0.003). These correlations all remained statistically significant on multivariable analysis (model R\u003csup\u003e2\u003c/sup\u003e = 0.247), while excluding bodyfat percentage due to collinearity with muscle mass percentage. Baseline R/L grip strength mismatch demonstrated no association with metabolic parameters. \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 5\u003c/strong\u003e provides univariable and multivariable linear regression models exploring parameters associated with pre- to post-intervention percent improvement in R/L mean grip strength. On univariable analysis, significant correlation to greater R/L mean grip strength improvement was observed across the following parameters: lower baseline FMS (R\u003csup\u003e2\u003c/sup\u003e = 0.151, p\u0026lt;0.001), lower baseline composite load lifted (R\u003csup\u003e2\u003c/sup\u003e = 0.086, p\u0026lt;0.001), and lower baseline Godin score, without significant correlation to pre/post-regimen improvements across the same parameters. Absolute improvement in pre- to post-regimen Godin scores were not significantly associated with improvements in mean R/L grip strength. Multivariable analysis of treatment and functional parameters demonstrated no significant correlation to percent improvement in R/L mean grip strength with a trend toward greater baseline composite load lifted (p = 0.06).\u003c/p\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eSignificant increases in grip strength were observed across breast cancer survivors completing a three-month, dose-escalated resistance training regimen employing high-intensity compound exercises. In line with the well-established utilization of grip strength as a simple and practical surrogate for strength and functional status, baseline grip strength was independently associated with greater baseline FMS and composite load lifted across compound exercises. As presently seen and previously reported, these increases in grip strength were observed alongside corresponding improvements in body composition, functional mobility, and quality of life.\u003csup\u003e\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u003c/sup\u003e These data may lend support for utilization of grip strength as a simple and practical surrogate parameter within breast cancer survivorship care.\u003c/p\u003e \u003cp\u003eAmong breast cancer patients at baseline, the present data demonstrate that greater baseline grip strength correlates not only to generalized muscular strength and functional parameters, but also to a range of favorable baseline metabolic parameters (muscle mass, phase angle, and resting metabolic rate).\u003csup\u003e\u003cspan additionalcitationids=\"CR20 CR21\" citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e\u003c/sup\u003e In the present data, such correlations in functional and metabolic parameters appear to be stronger than those of grip strength to oncologic treatment parameters. Aside from cytotoxic chemotherapy, oncologic treatments including surgical management of the breast and axilla, anti-estrogen therapy, and radiation therapy did not significantly correlate with baseline grip strength. Independent of exercise and strength goals, these data inform the use and interpretation of grip strength as a biomarker among breast cancer survivors.\u003c/p\u003e \u003cp\u003eGiven the well-defined association of grip strength to long-term mobility and quality of life, related improvements in grip strength, general muscular strength, and functional mobility are of prime importance.\u003csup\u003e\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e\u003c/sup\u003e Moreover, while relative survival rates for women with early stage disease approximate those of the general population,\u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e breast cancer patients are at high risk for obesity, sarcopenia, and decreased quality of life from systemic, surgical, and radiation therapies.\u003csup\u003e\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e,\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e In this high-risk population, the present data, while not randomized against a control group, may suggest that a high intensity exercise regimen may lead to significant improvements in strength and functional status which are quantifiable through the surrogate biomarker of grip strength. Notably, improvement in grip strength showed stronger association to baseline values rather than the magnitude of pre- to post-regimen improvement across strength, balance, and functional mobility parameters. Regarding quality of life, greater baseline grip strength was significantly associated with higher Godin scores, while improvements in hand grip strength were significantly associated with higher baseline Godin scores though not with greater improvements in pre- to post-regimen Godin scores. These findings may support the importance of strength training as a prophylactic measure in the general population, particularly among those of young and middle age. Although meta-analysis suggests 5.0 kg as a clinically meaningful difference in grip strength,\u003csup\u003e\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e\u003c/sup\u003e the present mean pre- to post-regimen improvement in grip strength of 3.5 kg (IQR 2.4\u0026ndash;4.5 kg) is better interpreted as a surrogate measure in their direct clinical context of related improvements across strength, functional, metabolic, and quality of life parameters.\u003c/p\u003e \u003cp\u003eThe present study has several limitations. While the reported median BMI of 29 is slightly above the median value for American women 50\u0026ndash;70 years old, participants who engage in exercise studies may nevertheless be more motivated to exercise than the general population.\u003csup\u003e\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e\u003c/sup\u003e The small number of patients across a number of prospective trial protocols may limit the ability to detect small but clinically meaningful associations in grip strength across oncologic treatment parameters as seen in other reports.\u003csup\u003e\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u003c/sup\u003e Limited longitudinal data address the utilization of grip strength across breast cancer survivors, regardless of adherence to an exercise regimen. Future studies should analyze correlation of grip strength to clinical and oncologic outcomes in the presence versus absence of an accompanying exercise regimen. Additionally, the majority of patients had stage I or II breast cancer, so the generalizability across more advanced disease may be limited. That being said, 44% of patients did undergo mastectomy as part of their treatment. Lastly, though changes were similar across the studies and the exercise regimen was the same, varying nutritional intakes of participants during the protocols may have impacted the results and is a confounding factor.\u003c/p\u003e \u003cp\u003eIn conclusion, among breast cancer survivors, grip strength correlates significantly with favorable increases across strength, functional, and metabolic parameters. Improvements in grip strength were associated with baseline values rather than pre- to post-regimen improvements across strength, balance, and functional mobility parameters. While the present authors would advocate for direct and longitudinal measurement of functional, metabolic, and strength parameters as a gold standard within the emerging field of exercise oncology, grip strength may be a valuable surrogate biomarker within breast cancer survivorship care, particularly in resource-limited settings.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eData Availability:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets generated and/or analyzed during the current study are not publicly available due to ongoing analysis and manuscript creation but are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflicts of Interest:\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eCEC receives income from books and lectures pertaining to nutrition and exercise and is on the scientific advisory board for Simply Good Foods. DJC, CP, JR, AKD, RK, and CH declare no conflict of interest.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding sources:\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eNone\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor contributions:\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eDJC, CP, JR, AKD, CEC: Design, data analysis, manuscript drafting, revision, and final approval. CH and RK: Data analysis, manuscript drafting, revision, and final approval.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eL\u0026oacute;pez-Bueno, R. \u003cem\u003eet al.\u003c/em\u003e Associations of handgrip strength with all-cause and cancer mortality in older adults: a prospective cohort study in 28 countries. \u003cem\u003eAge Ageing\u003c/em\u003e \u003cstrong\u003e51\u003c/strong\u003e, 1\u0026ndash;11 (2022).\u003c/li\u003e\n\u003cli\u003eWang, Y. \u003cem\u003eet al.\u003c/em\u003e Association of grip strength and comorbidities with all-cause mortality in the older hypertensive adults. \u003cem\u003eFront. Public Heal.\u003c/em\u003e \u003cstrong\u003e11\u003c/strong\u003e, 1162425 (2023).\u003c/li\u003e\n\u003cli\u003eMarcadis, A. R., Morris, L. G. T. \u0026amp; Marti, J. L. Relative Survival With Early-Stage Breast Cancer in Screened and Unscreened Populations. \u003cem\u003eMayo Clin. Proc.\u003c/em\u003e \u003cstrong\u003e97\u003c/strong\u003e, 2316\u0026ndash;2323 (2022).\u003c/li\u003e\n\u003cli\u003eParra-Soto, S., Pell, J. P., Celis-Morales, C. \u0026amp; Ho, F. K. Absolute and relative grip strength as predictors of cancer: prospective cohort study of 445 552 participants in UK Biobank. \u003cem\u003eJ. Cachexia. Sarcopenia Muscle\u003c/em\u003e \u003cstrong\u003e13\u003c/strong\u003e, 325\u0026ndash;332 (2022).\u003c/li\u003e\n\u003cli\u003eCantarero-Villanueva, I. \u003cem\u003eet al.\u003c/em\u003e The handgrip strength test as a measure of function in breast cancer survivors: relationship to cancer-related symptoms and physical and physiologic parameters. \u003cem\u003eAm. J. Phys. Med. Rehabil.\u003c/em\u003e \u003cstrong\u003e91\u003c/strong\u003e, 774\u0026ndash;782 (2012).\u003c/li\u003e\n\u003cli\u003ePaek, J. \u0026amp; Choi, Y. J. Association between hand grip strength and impaired health-related quality of life in Korean cancer survivors: a cross-sectional study. \u003cem\u003eBMJ Open\u003c/em\u003e \u003cstrong\u003e9\u003c/strong\u003e, (2019).\u003c/li\u003e\n\u003cli\u003eZhuang, C. Le \u003cem\u003eet al.\u003c/em\u003e Associations of low handgrip strength with cancer mortality: a multicentre observational study. \u003cem\u003eJ. Cachexia. Sarcopenia Muscle\u003c/em\u003e \u003cstrong\u003e11\u003c/strong\u003e, 1476 (2020).\u003c/li\u003e\n\u003cli\u003eGuigni, B. A. \u003cem\u003eet al.\u003c/em\u003e Skeletal muscle atrophy and dysfunction in breast cancer patients: role for chemotherapy-derived oxidant stress. \u003cem\u003eAm. J. Physiol. Cell Physiol.\u003c/em\u003e \u003cstrong\u003e315\u003c/strong\u003e, C744\u0026ndash;C756 (2018).\u003c/li\u003e\n\u003cli\u003eKlassen, O. \u003cem\u003eet al.\u003c/em\u003e Muscle strength in breast cancer patients receiving different treatment regimes. \u003cem\u003eJ. Cachexia. Sarcopenia Muscle\u003c/em\u003e \u003cstrong\u003e8\u003c/strong\u003e, 305\u0026ndash;316 (2017).\u003c/li\u003e\n\u003cli\u003eVan der Weijden-Van Doornik, E. M., Slot, D. E., Burtin, C. \u0026amp; van der Weijden, G. A. Grip Strength in Women Being Treated for Breast Cancer and Receiving Adjuvant Endocrine Therapy: Systematic Review. \u003cem\u003ePhys. Ther.\u003c/em\u003e \u003cstrong\u003e97\u003c/strong\u003e, 904\u0026ndash;914 (2017).\u003c/li\u003e\n\u003cli\u003eCarpenter, D. J. \u003cem\u003eet al.\u003c/em\u003e EXERT‐BC: A pilot study of an exercise regimen designed to improve functional mobility, body composition, and strength after the treatment for breast cancer. \u003cem\u003eCancer Med.\u003c/em\u003e \u003cstrong\u003e13\u003c/strong\u003e, e7001 (2024).\u003c/li\u003e\n\u003cli\u003eShaibi, G. Q. \u003cem\u003eet al.\u003c/em\u003e Effects of Resistance Training on Insulin Sensitivity in Overweight Latino Adolescent Males. \u003cem\u003eMed. Sci. Sport. Exerc.\u003c/em\u003e \u003cstrong\u003e38\u003c/strong\u003e, 1208\u0026ndash;1215 (2006).\u003c/li\u003e\n\u003cli\u003eSchoenfeld, B. J. The Mechanisms of Muscle Hypertrophy and Their Application to Resistance Training. \u003cem\u003eJ. Strength Cond. Res.\u003c/em\u003e \u003cstrong\u003e24\u003c/strong\u003e, 2857\u0026ndash;2872 (2010).\u003c/li\u003e\n\u003cli\u003eChamp, C. E. \u003cem\u003eet al.\u003c/em\u003e EXERT-BC: Prospective study of an exercise regimen after treatment for breast cancer. \u003cem\u003eSport. Med. Int. Open\u003c/em\u003e (2023). doi:10.1055/a-2193-0922\u003c/li\u003e\n\u003cli\u003eSchoenfeld, B. \u0026amp; Grgic, J. Evidence-based guidelines for resistance training volume to maximize muscle hypertrophy. \u003cem\u003eStrength Cond. J.\u003c/em\u003e \u003cstrong\u003e40\u003c/strong\u003e, 107\u0026ndash;112 (2018).\u003c/li\u003e\n\u003cli\u003eSchoenfeld, B. J., Ogborn, D. \u0026amp; Krieger, J. W. Dose-response relationship between weekly resistance training volume and increases in muscle mass: A systematic review and meta-analysis. \u003cem\u003eJ. Sports Sci.\u003c/em\u003e \u003cstrong\u003e35\u003c/strong\u003e, 1073\u0026ndash;1082 (2017).\u003c/li\u003e\n\u003cli\u003eChamp, C. E. \u003cem\u003eet al.\u003c/em\u003e Resistance Training for Patients with Cancer : A Conceptual Framework for Maximizing Strength , Power , Functional Mobility , and Body Composition to Optimize Health and Outcomes. \u003cem\u003eSport. Med.\u003c/em\u003e (2022). doi:10.1007/s40279-022-01759-z\u003c/li\u003e\n\u003cli\u003eSousa-Santos, A. R. \u0026amp; Amaral, T. F. Differences in handgrip strength protocols to identify sarcopenia and frailty - a systematic review. \u003cem\u003eBMC Geriatr.\u003c/em\u003e \u003cstrong\u003e17\u003c/strong\u003e, 238 (2017).\u003c/li\u003e\n\u003cli\u003eBohannon, R. W., Magasi, S. R., Bubela, D. J., Wang, Y. C. \u0026amp; Gershon, R. C. Grip and knee extension muscle strength reflect a common construct among adults. \u003cem\u003eMuscle Nerve\u003c/em\u003e \u003cstrong\u003e46\u003c/strong\u003e, 555\u0026ndash;558 (2012).\u003c/li\u003e\n\u003cli\u003eBohanon, R. W. Are hand-grip and knee extension strength reflective of a common construct? \u003cem\u003ePercept. Mot. Skills\u003c/em\u003e \u003cstrong\u003e114\u003c/strong\u003e, 514\u0026ndash;518 (2012).\u003c/li\u003e\n\u003cli\u003eSoyuer, F., Cankurtaran, F., Menevşe, \u0026Ouml;. \u0026amp; Zararsiz, G. E. Examination of the correlation between hand grip strength and muscle mass, balance, mobility, and daily life activities in elderly individuals living in nursing homes. \u003cem\u003ehttps://doi.org/10.3233/WOR-205075\u003c/em\u003e \u003cstrong\u003e74\u003c/strong\u003e, 1371\u0026ndash;1378 (2022).\u003c/li\u003e\n\u003cli\u003eBohannon, R. W. Minimal clinically important difference for grip strength: a systematic review. \u003cem\u003eJ. Phys. Ther. Sci.\u003c/em\u003e \u003cstrong\u003e31\u003c/strong\u003e, 75 (2019).\u003c/li\u003e\n\u003cli\u003eRantanen, T. \u003cem\u003eet al.\u003c/em\u003e Midlife hand grip strength as a predictor of old age disability. \u003cem\u003eJAMA\u003c/em\u003e \u003cstrong\u003e281\u003c/strong\u003e, 558\u0026ndash;560 (1999).\u003c/li\u003e\n\u003cli\u003eChen, Z. \u003cem\u003eet al.\u003c/em\u003e Body Mass Index, Waist Circumference, and Mortality in a Large Multiethnic Postmenopausal Cohort-Results from the Women\u0026rsquo;s Health Initiative. \u003cem\u003eJ. Am. Geriatr. Soc.\u003c/em\u003e \u003cstrong\u003e65\u003c/strong\u003e, 1907\u0026ndash;1915 (2017).\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003e\u003cstrong\u003eTable 1:\u003c/strong\u003e Participant demographics. Abbreviations: IQR, interquartile range; BMI, body mass index; BMC, bone mineral content; RMR, resting metabolic rate; DCIS, ductal carcinoma in situ; AHT, anti-hormonal therapy; CHT, chemotherapy; RT, radiation therapy; SLNB, sentinel lymph node biopsy; ALND, axillary lymph node dissection\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" align=\"\" width=\"504\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 246px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 120px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMedian\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 138px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eIQR\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 246px;\"\u003e\n \u003cp\u003eAge, years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 120px;\"\u003e\n \u003cp\u003e54.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 138px;\"\u003e\n \u003cp\u003e46.3 - 64.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 246px;\"\u003e\n \u003cp\u003eBody mass index, kg/m\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 120px;\"\u003e\n \u003cp\u003e28.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 138px;\"\u003e\n \u003cp\u003e24.4 - 33.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 246px;\"\u003e\n \u003cp\u003eBodyfat percentage\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 120px;\"\u003e\n \u003cp\u003e27.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 138px;\"\u003e\n \u003cp\u003e33.5 - 43.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 246px;\"\u003e\n \u003cp\u003eMuscle mass percentage\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 120px;\"\u003e\n \u003cp\u003e33.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 138px;\"\u003e\n \u003cp\u003e30.8 - 36.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 246px;\"\u003e\n \u003cp\u003eBone mineral content, g/cm\u003csup\u003e3\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 120px;\"\u003e\n \u003cp\u003e6.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 138px;\"\u003e\n \u003cp\u003e5.6 - 6.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 246px;\"\u003e\n \u003cp\u003ePhase angle, degrees\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 120px;\"\u003e\n \u003cp\u003e5.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 138px;\"\u003e\n \u003cp\u003e4.6 - 5.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 246px;\"\u003e\n \u003cp\u003eResting metabolic rate, calories/day\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 120px;\"\u003e\n \u003cp\u003e1370\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 138px;\"\u003e\n \u003cp\u003e1268 - 1449\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 246px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 120px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eN\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 138px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 246px;\"\u003e\n \u003cp\u003eExercise at time of enrollment\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 120px;\"\u003e\n \u003cp\u003e56\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 138px;\"\u003e\n \u003cp\u003e40.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 246px;\"\u003e\n \u003cp\u003eStage\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 120px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 138px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 246px;\"\u003e\n \u003cp\u003e\u0026nbsp; 0; Ductal Carcinoma In Situ\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 120px;\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 138px;\"\u003e\n \u003cp\u003e8.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 246px;\"\u003e\n \u003cp\u003e\u0026nbsp; I\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 120px;\"\u003e\n \u003cp\u003e75\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 138px;\"\u003e\n \u003cp\u003e54.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 246px;\"\u003e\n \u003cp\u003e\u0026nbsp; II\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 120px;\"\u003e\n \u003cp\u003e29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 138px;\"\u003e\n \u003cp\u003e21\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 246px;\"\u003e\n \u003cp\u003e\u0026nbsp; III\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 120px;\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 138px;\"\u003e\n \u003cp\u003e10.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 246px;\"\u003e\n \u003cp\u003e\u0026nbsp; IV\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 120px;\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 138px;\"\u003e\n \u003cp\u003e5.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 246px;\"\u003e\n \u003cp\u003eReceipt of anti-estrogen therapy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 120px;\"\u003e\n \u003cp\u003e97\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 138px;\"\u003e\n \u003cp\u003e70.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 246px;\"\u003e\n \u003cp\u003eReceipt of cytotoxic chemotherapy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 120px;\"\u003e\n \u003cp\u003e23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 138px;\"\u003e\n \u003cp\u003e16.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 246px;\"\u003e\n \u003cp\u003eReceipt of radiation therapy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 120px;\"\u003e\n \u003cp\u003e111\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 138px;\"\u003e\n \u003cp\u003e80.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 246px;\"\u003e\n \u003cp\u003eReceipt of mastectomy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 120px;\"\u003e\n \u003cp\u003e60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 138px;\"\u003e\n \u003cp\u003e43.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 246px;\"\u003e\n \u003cp\u003eAxillary management\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 120px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 138px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 246px;\"\u003e\n \u003cp\u003e\u0026nbsp; Sentinel lymph node biopsy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 120px;\"\u003e\n \u003cp\u003e114\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 138px;\"\u003e\n \u003cp\u003e82.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 246px;\"\u003e\n \u003cp\u003e\u0026nbsp; Axillary lymph node dissection\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 120px;\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 138px;\"\u003e\n \u003cp\u003e14.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2:\u003c/strong\u003e Grip strength, functional, and strength parameters at baseline and at post-intervention.\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"553\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 167px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 133px;\"\u003e\n \u003cp\u003eBaseline\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 132px;\"\u003e\n \u003cp\u003ePost-Intervention\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 121px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 167px;\"\u003e\n \u003cp\u003e\u003cem\u003eGrip parameters\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" style=\"width: 265px;\"\u003e\n \u003cp\u003eMedian (IQR)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 121px;\"\u003e\n \u003cp\u003ePaired p value\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 167px;\"\u003e\n \u003cp\u003eR/L Maximum\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 133px;\"\u003e\n \u003cp\u003e24 (20-28)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 132px;\"\u003e\n \u003cp\u003e27 (24-30)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 121px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 167px;\"\u003e\n \u003cp\u003eR/L Minimum\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 133px;\"\u003e\n \u003cp\u003e20 (16-24)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 132px;\"\u003e\n \u003cp\u003e24 (20-27)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 121px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 167px;\"\u003e\n \u003cp\u003eR/L Mean\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 133px;\"\u003e\n \u003cp\u003e22.5 (17.6-26.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 132px;\"\u003e\n \u003cp\u003e26.0 (22.1-28.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 121px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 167px;\"\u003e\n \u003cp\u003eR/L Mismatch, %\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 133px;\"\u003e\n \u003cp\u003e13.3 (6.5 - 25.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 132px;\"\u003e\n \u003cp\u003e8.7 (3.9 - 15.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 121px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 167px;\"\u003e\n \u003cp\u003e\u003cem\u003eNon-grip parameters\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 133px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 121px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 167px;\"\u003e\n \u003cp\u003eY balance, L/R Mean\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 133px;\"\u003e\n \u003cp\u003e77.0 (66.5-85.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 132px;\"\u003e\n \u003cp\u003e86.8 (79.4-95.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 121px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 167px;\"\u003e\n \u003cp\u003eY balance, % Mismatch\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 133px;\"\u003e\n \u003cp\u003e3.8 (1.4-8.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 132px;\"\u003e\n \u003cp\u003e3.4 (1.7-6.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 121px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.010\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 167px;\"\u003e\n \u003cp\u003eFunctional mobility screen score\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 133px;\"\u003e\n \u003cp\u003e10 (9-12)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 132px;\"\u003e\n \u003cp\u003e13 (10-15)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 121px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 167px;\"\u003e\n \u003cp\u003eComposite Load\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 133px;\"\u003e\n \u003cp\u003e4129 (3361-5161)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 132px;\"\u003e\n \u003cp\u003e6162 (4854-7315)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 121px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e*Pre/post intervention improvement in Grip L/R mean was 12.6% (1.8 - 31.5%)\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3:\u003c/strong\u003e Univariate and multivariable linear regression of parameters associated with baseline R/L mean grip strength\u0026nbsp;\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"558\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 204px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66px;\"\u003e\n \u003cp\u003eF value\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 84px;\"\u003e\n \u003cp\u003eR squared\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 102px;\"\u003e\n \u003cp\u003eUVA p value\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 102px;\"\u003e\n \u003cp\u003eMVA p value\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 204px;\"\u003e\n \u003cp\u003eAge, years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66px;\"\u003e\n \u003cp\u003e17.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 84px;\"\u003e\n \u003cp\u003e0.116\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 102px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 102px;\"\u003e\n \u003cp\u003e0.326\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 204px;\"\u003e\n \u003cp\u003eBreast cancer stage: II or greater\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.028\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 84px;\"\u003e\n \u003cp\u003e0.0002\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 102px;\"\u003e\n \u003cp\u003e0.867\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 102px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 204px;\"\u003e\n \u003cp\u003eReceipt of anti-estrogen therapy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.123\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 84px;\"\u003e\n \u003cp\u003e0.0009\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 102px;\"\u003e\n \u003cp\u003e0.726\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 102px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 204px;\"\u003e\n \u003cp\u003eReceipt of cytotoxic chemotherapy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66px;\"\u003e\n \u003cp\u003e5.735\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 84px;\"\u003e\n \u003cp\u003e0.0408\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 102px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.018\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 102px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 204px;\"\u003e\n \u003cp\u003eReceipt of radiation therapy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66px;\"\u003e\n \u003cp\u003e3.696\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 84px;\"\u003e\n \u003cp\u003e0.0265\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 102px;\"\u003e\n \u003cp\u003e0.057\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 102px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 204px;\"\u003e\n \u003cp\u003eReceipt of mastectomy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66px;\"\u003e\n \u003cp\u003e3.221\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 84px;\"\u003e\n \u003cp\u003e0.0231\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 102px;\"\u003e\n \u003cp\u003e0.075\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 102px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 204px;\"\u003e\n \u003cp\u003eReceipt of axillary lymph node dissection\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.036\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 84px;\"\u003e\n \u003cp\u003e0.0002\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 102px;\"\u003e\n \u003cp\u003e0.85\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 102px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 204px;\"\u003e\n \u003cp\u003eBaseline Y-balance mean\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66px;\"\u003e\n \u003cp\u003e38.26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 84px;\"\u003e\n \u003cp\u003e0.22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 102px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 102px;\"\u003e\n \u003cp\u003e0.467\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 204px;\"\u003e\n \u003cp\u003eBaseline Y-balance mismatch\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66px;\"\u003e\n \u003cp\u003e8.65\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 84px;\"\u003e\n \u003cp\u003e0.0598\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 102px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.004\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 102px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 204px;\"\u003e\n \u003cp\u003eBaseline functional mobility screen score\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66px;\"\u003e\n \u003cp\u003e39.83\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 84px;\"\u003e\n \u003cp\u003e0.2265\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 102px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 102px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.032\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 204px;\"\u003e\n \u003cp\u003eBaseline Composite load\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66px;\"\u003e\n \u003cp\u003e62.67\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 84px;\"\u003e\n \u003cp\u003e0.316\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 102px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 102px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 204px;\"\u003e\n \u003cp\u003eBaseline Godin score\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66px;\"\u003e\n \u003cp\u003e12.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 84px;\"\u003e\n \u003cp\u003e0.083\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 102px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 102px;\"\u003e\n \u003cp\u003e0.268\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 4:\u003c/strong\u003e Univariable and multivariable linear regression with grip strength as the independent variable with respect to metabolic parameters.\u0026nbsp;\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"624\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 241px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGrip R/L Mean, Baseline\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 77px;\"\u003e\n \u003cp\u003eF value\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 90px;\"\u003e\n \u003cp\u003eR squared\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 108px;\"\u003e\n \u003cp\u003eUVA p value\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003eMVA p value\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 241px;\"\u003e\n \u003cp\u003eBaseline bodyfat, %\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 77px;\"\u003e\n \u003cp\u003e8.147\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 90px;\"\u003e\n \u003cp\u003e0.0565\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 108px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.005\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 241px;\"\u003e\n \u003cp\u003eBaseline muscle mass, %\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 77px;\"\u003e\n \u003cp\u003e9.463\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 90px;\"\u003e\n \u003cp\u003e0.0651\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 108px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.002\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.004\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 241px;\"\u003e\n \u003cp\u003eBaseline whole body phase angle, degrees\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 77px;\"\u003e\n \u003cp\u003e31.68\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 90px;\"\u003e\n \u003cp\u003e0.183\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 108px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 241px;\"\u003e\n \u003cp\u003eBaseline Inbody resting metabolic rate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 77px;\"\u003e\n \u003cp\u003e9.211\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 90px;\"\u003e\n \u003cp\u003e0.0566\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 108px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.003\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.011\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 241px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGrip, R/L Mismatch Baseline\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 77px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 90px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 108px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 241px;\"\u003e\n \u003cp\u003eBaseline bodyfat, %\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 77px;\"\u003e\n \u003cp\u003e1.675\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 90px;\"\u003e\n \u003cp\u003e0.0122\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 108px;\"\u003e\n \u003cp\u003e0.198\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 241px;\"\u003e\n \u003cp\u003eBaseline muscle mass, %\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 77px;\"\u003e\n \u003cp\u003e0.6206\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 90px;\"\u003e\n \u003cp\u003e0.0045\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 108px;\"\u003e\n \u003cp\u003e0.432\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 241px;\"\u003e\n \u003cp\u003eBaseline whole body phase angle, degrees\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 77px;\"\u003e\n \u003cp\u003e0.0128\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 90px;\"\u003e\n \u003cp\u003e0.00009\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 108px;\"\u003e\n \u003cp\u003e0.910\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 241px;\"\u003e\n \u003cp\u003eBaseline Inbody resting metabolic rate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 77px;\"\u003e\n \u003cp\u003e0.6678\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 90px;\"\u003e\n \u003cp\u003e0.0049\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 108px;\"\u003e\n \u003cp\u003e0.415\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 5:\u003c/strong\u003e Univariate and multivariable linear regression of parameters associated with pre- to post-intervention improvement in R/L mean grip strength\u0026nbsp;\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"575\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 287px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66px;\"\u003e\n \u003cp\u003eF value\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 84px;\"\u003e\n \u003cp\u003eR squared\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 78px;\"\u003e\n \u003cp\u003eUVA p\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 60px;\"\u003e\n \u003cp\u003eMVA p\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 287px;\"\u003e\n \u003cp\u003eAge, years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66px;\"\u003e\n \u003cp\u003e2.704\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 84px;\"\u003e\n \u003cp\u003e0.195\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 78px;\"\u003e\n \u003cp\u003e0.102\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 60px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 287px;\"\u003e\n \u003cp\u003eBreast cancer stage, II or greater\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 84px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 78px;\"\u003e\n \u003cp\u003e0.992\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 60px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 287px;\"\u003e\n \u003cp\u003eReceipt of anti-estrogen therapy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.07\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 84px;\"\u003e\n \u003cp\u003e0.005\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 78px;\"\u003e\n \u003cp\u003e0.792\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 60px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 287px;\"\u003e\n \u003cp\u003eReceipt of cytotoxic chemotherapy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66px;\"\u003e\n \u003cp\u003e1.409\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 84px;\"\u003e\n \u003cp\u003e0.0103\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 78px;\"\u003e\n \u003cp\u003e0.237\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 60px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 287px;\"\u003e\n \u003cp\u003eReceipt of adjuvant radiation therapy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.273\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 84px;\"\u003e\n \u003cp\u003e0.002\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 78px;\"\u003e\n \u003cp\u003e0.602\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 60px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 287px;\"\u003e\n \u003cp\u003eReceipt of mastectomy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.869\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 84px;\"\u003e\n \u003cp\u003e0.006\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 78px;\"\u003e\n \u003cp\u003e0.353\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 60px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 287px;\"\u003e\n \u003cp\u003eReceipt of axillary lymph node dissection\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66px;\"\u003e\n \u003cp\u003e3.231\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 84px;\"\u003e\n \u003cp\u003e0.0234\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 78px;\"\u003e\n \u003cp\u003e0.074\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 60px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 287px;\"\u003e\n \u003cp\u003eY balance mean, baseline\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66px;\"\u003e\n \u003cp\u003e9.749\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 84px;\"\u003e\n \u003cp\u003e0.0669\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 78px;\"\u003e\n \u003cp\u003e0.002\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 60px;\"\u003e\n \u003cp\u003e0.17\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 287px;\"\u003e\n \u003cp\u003eY balance mean, % improvement\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66px;\"\u003e\n \u003cp\u003e3.743\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 84px;\"\u003e\n \u003cp\u003e0.0268\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 78px;\"\u003e\n \u003cp\u003e0.055\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 60px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 287px;\"\u003e\n \u003cp\u003eY balance mismatch, baseline\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66px;\"\u003e\n \u003cp\u003e2.207\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 84px;\"\u003e\n \u003cp\u003e0.16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 78px;\"\u003e\n \u003cp\u003e0.14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 60px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 287px;\"\u003e\n \u003cp\u003eY balance mismatch, % improvement\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66px;\"\u003e\n \u003cp\u003e2.498\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 84px;\"\u003e\n \u003cp\u003e0.018\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 78px;\"\u003e\n \u003cp\u003e0.1163\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 60px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 287px;\"\u003e\n \u003cp\u003eFunctional mobility screen, baseline\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66px;\"\u003e\n \u003cp\u003e24.16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 84px;\"\u003e\n \u003cp\u003e0.151\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 78px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 60px;\"\u003e\n \u003cp\u003e0.751\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 287px;\"\u003e\n \u003cp\u003eFunctional mobility screen, absolute improvement\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66px;\"\u003e\n \u003cp\u003e1.904\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 84px;\"\u003e\n \u003cp\u003e0.138\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 78px;\"\u003e\n \u003cp\u003e0.17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 60px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 287px;\"\u003e\n \u003cp\u003eComposite load baseline\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66px;\"\u003e\n \u003cp\u003e12.75\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 84px;\"\u003e\n \u003cp\u003e0.0857\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 78px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 60px;\"\u003e\n \u003cp\u003e0.064\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 287px;\"\u003e\n \u003cp\u003eComposite Load, % improvement\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.5982\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 84px;\"\u003e\n \u003cp\u003e0.0044\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 78px;\"\u003e\n \u003cp\u003e0.441\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 60px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 287px;\"\u003e\n \u003cp\u003eGodin baseline\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66px;\"\u003e\n \u003cp\u003e8.329\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 84px;\"\u003e\n \u003cp\u003e0.0577\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 78px;\"\u003e\n \u003cp\u003e0.004\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 60px;\"\u003e\n \u003cp\u003e0.09\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 287px;\"\u003e\n \u003cp\u003eGodin pre/post absolute improvement\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66px;\"\u003e\n \u003cp\u003e3.341\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 84px;\"\u003e\n \u003cp\u003e0.024\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 78px;\"\u003e\n \u003cp\u003e0.069\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 60px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 287px;\"\u003e\n \u003cp\u003eBodyfat percentage, baseline\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66px;\"\u003e\n \u003cp\u003e5.592\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 84px;\"\u003e\n \u003cp\u003e0.03243\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 78px;\"\u003e\n \u003cp\u003e0.020\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 60px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 287px;\"\u003e\n \u003cp\u003eMuscle mass percentage, baseline\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66px;\"\u003e\n \u003cp\u003e8.159\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 84px;\"\u003e\n \u003cp\u003e0.04966\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 78px;\"\u003e\n \u003cp\u003e0.005\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 60px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 287px;\"\u003e\n \u003cp\u003eWhole body phase angle, baseline\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66px;\"\u003e\n \u003cp\u003e8.025\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 84px;\"\u003e\n \u003cp\u003e0.04878\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 78px;\"\u003e\n \u003cp\u003e0.005\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 60px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 287px;\"\u003e\n \u003cp\u003eBaseline Inbody resting metabolic rate, baseline\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66px;\"\u003e\n \u003cp\u003e2.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 84px;\"\u003e\n \u003cp\u003e0.1226\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 78px;\"\u003e\n \u003cp\u003e0.1027\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 60px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Grip strength, breast cancer, resistance training, exercise science, body composition","lastPublishedDoi":"10.21203/rs.3.rs-5822657/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5822657/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eGrip strength, a surrogate for quantifying strength, correlates with function and longevity. However, this relationship is less clear in women with breast cancer. 138 women undergoing oncologic treatment for breast cancer were enrolled across three institutional review board-approved protocols with three months of resistance training with pre and post assessment of body composition, phase angle, functional movement screen (FMS), balance, weight lifted (load), quality of life, activity levels, and hand grip strength.\u003c/p\u003e \u003cp\u003eSignificant increases in maximum, minimum, and mean grip strength were seen. Mean grip strength increased by 12.6% and 3.5 kg. Right/left (R/L) mismatch significantly decreased from baseline to post-intervention (13.3 to 8.7%). On univariable analysis, greater baseline mean grip strength was associated with younger age, greater baseline FMS, composite load lifted, activity levels, and decreased R/L balance mismatch. On multivariable analysis, greater mean grip strength was independently associated with greater baseline mobility and composite load lifted. Baseline mean grip strength was associated with baseline lower bodyfat percentage and greater muscle mass, whole body phase angle, and resting metabolic rate (all significant on multivariable analysis, R\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;0.247). Grip strength may be a valuable surrogate biomarker within breast cancer survivorship care, particularly in resource-limited settings.\u003c/p\u003e","manuscriptTitle":"Grip Strength as a Surrogate Measure of Strength, Functional, and Metabolic Parameter Increases in Breast Cancer Survivors Undergoing an Exercise Regimen","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-04-29 10:02:11","doi":"10.21203/rs.3.rs-5822657/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Accepted","date":"2025-05-02T01:58:13+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-04-29T20:34:21+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-04-28T16:17:09+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"255940150455409640219065456851812518426","date":"2025-04-27T19:41:12+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"57102583754989277231605306594441747644","date":"2025-04-27T16:43:27+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-04-26T17:19:29+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-04-22T11:47:43+00:00","index":"","fulltext":""},{"type":"submitted","content":"Scientific Reports","date":"2025-04-05T15:03:18+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"cd7dc36e-49aa-4a07-b1eb-d6c71ce76ba4","owner":[],"postedDate":"April 29th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[{"id":47805462,"name":"Biological sciences/Cancer/Breast cancer"},{"id":47805463,"name":"Health sciences/Health care/Disease prevention/Lifestyle modification"}],"tags":[],"updatedAt":"2025-05-12T16:06:31+00:00","versionOfRecord":{"articleIdentity":"rs-5822657","link":"https://doi.org/10.1038/s41598-025-00867-w","journal":{"identity":"scientific-reports","isVorOnly":false,"title":"Scientific Reports"},"publishedOn":"2025-05-06 15:56:53","publishedOnDateReadable":"May 6th, 2025"},"versionCreatedAt":"2025-04-29 10:02:11","video":"","vorDoi":"10.1038/s41598-025-00867-w","vorDoiUrl":"https://doi.org/10.1038/s41598-025-00867-w","workflowStages":[]},"version":"v1","identity":"rs-5822657","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5822657","identity":"rs-5822657","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}