ORIGINAL ARTICLE: BIOLOGY

Comparative analysis of the maximal respiratory pressure and peak expiratory flow rate in diagnosing probable respiratory sarcopenia – The Otassha Study

Takeshi Kera,

Corresponding Author

Takeshi Kera

[email protected]

orcid.org/0000-0002-2356-0188

Department of Physical Therapy, Takasaki University of Health and Welfare, Gunma, Japan

Research Team for Human Care, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan

Correspondence

Takeshi Kera PT PhD, Takasaki University of Health and Welfare, 501 Nakaorui-machi, Takasaki, Gunma 370-0033, Japan.

Email: [email protected]

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Hisashi Kawai,

Hisashi Kawai

orcid.org/0000-0003-3015-6041

Research Team for Human Care, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan

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Manami Ejiri,

Manami Ejiri

orcid.org/0000-0003-3544-4587

Research Team for Human Care, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan

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Keigo Imamura,

Keigo Imamura

Research Team for Human Care, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan

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Hirohiko Hirano,

Hirohiko Hirano

Research Team for Promoting Independence and Mental Health, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan

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Yoshinori Fujiwara,

Yoshinori Fujiwara

orcid.org/0000-0002-3384-1696

Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan

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Kazushige Ihara,

Kazushige Ihara

Department of Social Medicine, Hirosaki University School of Medicine, Aomori, Japan

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Shuichi Obuchi,

Shuichi Obuchi

Research Team for Human Care, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan

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Takeshi Kera,

Corresponding Author

Takeshi Kera

[email protected]

orcid.org/0000-0002-2356-0188

Department of Physical Therapy, Takasaki University of Health and Welfare, Gunma, Japan

Research Team for Human Care, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan

Correspondence

Takeshi Kera PT PhD, Takasaki University of Health and Welfare, 501 Nakaorui-machi, Takasaki, Gunma 370-0033, Japan.

Email: [email protected]

Search for more papers by this author

Hisashi Kawai,

Hisashi Kawai

orcid.org/0000-0003-3015-6041

Research Team for Human Care, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan

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Manami Ejiri,

Manami Ejiri

orcid.org/0000-0003-3544-4587

Research Team for Human Care, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan

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Keigo Imamura,

Keigo Imamura

Research Team for Human Care, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan

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Hirohiko Hirano,

Hirohiko Hirano

Research Team for Promoting Independence and Mental Health, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan

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Yoshinori Fujiwara,

Yoshinori Fujiwara

orcid.org/0000-0002-3384-1696

Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan

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Kazushige Ihara,

Kazushige Ihara

Department of Social Medicine, Hirosaki University School of Medicine, Aomori, Japan

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Shuichi Obuchi,

Shuichi Obuchi

Research Team for Human Care, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan

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First published: 21 July 2025

https://doi.org/10.1111/ggi.70124

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Abstract

Aim

The availability of diverse assessment methods, based on different devices and conditions, for respiratory sarcopenia is crucial for developing community health initiatives. Thus, in this study, we aimed to compare the concordance in diagnosing respiratory sarcopenia based on the maximal respiratory pressure (MRP) and peak expiratory flow rate (PEFR), which are specific indicators of respiratory-muscle strength, in a community-dwelling older adult population.

Methods

In the Otassha Study conducted in 2023, 499 community-dwelling adults aged >65 years in Itabashi Ward (184 men and 315 women) were evaluated for MRP, PEFR, walking speed, grip strength, and appendicular skeletal muscle mass (ASM). We determined two respiratory-sarcopenia models using low skeletal muscle mass and low MRP/PEFR (both <80% for predicted values). Pearson correlation coefficients were used to compare each measurement; the agreement between respiratory sarcopenia diagnosed using low MRP and PEFR was evaluated using kappa coefficients (κ).

Results

PEFR was correlated with MRP (maximal expiratory pressure: r = 0.415; maximal inspiratory pressure: r = 0.380; P < 0.01, respectively). A moderate level of agreement was found between respiratory sarcopenia diagnosed using MRP and that diagnosed using PEFR (κ = 0.597, match rate = 87.2%), suggesting a fair consistency level between the methods.

Conclusions

Although PEFR had a moderate correlation with MRP, the concordance of respiratory sarcopenia diagnosed using the two methods was moderate, suggesting that the two approaches are partially interchangeable and are complementary. The findings showed that PEFR, proposed as an alternative to MRP, is valid for diagnosing respiratory sarcopenia, supporting its role as an alternative to the gold standard for evaluating respiratory-muscle strength. Geriatr Gerontol Int 2025; ••: ••–••.

Open Research

Data Availability Statement

Research data are not shared.

Supporting Information

References

1Kim J, Davenport P, Sapienza C. Effect of expiratory muscle strength training on elderly cough function. Arch Gerontol Geriatr 2009; 48: 361–366.
10.1016/j.archger.2008.03.006
PubMed Web of Science® Google Scholar
2Elliott JE, Greising SM, Mantilla CB, Sieck GC. Functional impact of sarcopenia in respiratory muscles. Respir Physiol Neurobiol 2016; 226: 137–146.
10.1016/j.resp.2015.10.001
CAS PubMed Web of Science® Google Scholar
3Lee J, Nam K, Lee S et al. Sarcopenia of respiratory muscle in lung transplantation patients is not a poor predictor of early survival. J Heart Lung Transplant 2016; 35: S136.
10.1016/j.healun.2016.01.373
Web of Science® Google Scholar
4Kera T, Kawai H, Ejiri M et al. Respiratory sarcopenia is a predictor of all-cause mortality in community-dwelling older adults-the Otassha study. J Cachexia Sarcopenia Muscle 2023; 14: 1894–1899.
10.1002/jcsm.13266
PubMed Web of Science® Google Scholar
5Sun C, Hirata Y, Kawahara T et al. Diagnosis of respiratory sarcopenia for stratifying postoperative risk in non-small cell lung cancer. JAMA Surg 2025; 160: 66–73.
10.1001/jamasurg.2024.4800
PubMed Web of Science® Google Scholar
6Kera T, Kawai H, Hirano H et al. Definition of respiratory sarcopenia with peak expiratory flow rate. J Am Med Dir Assoc 2019; 20: 1021–1025.
10.1016/j.jamda.2018.12.013
PubMed Web of Science® Google Scholar
7Rosenberg IH. Summary comments; epidemiologic and methodologic problems in determining nutritional status of older persons. Am J Clin Nutr 1989; 50: 1231–1233.
10.1093/ajcn/50.5.1231
Google Scholar
8Sato S, Miyazaki S, Tamaki A et al. Respiratory sarcopenia: a position paper by four professional organizations. Geriatr Gerontol Int 2023; 23: 5–15.
10.1111/ggi.14519
PubMed Web of Science® Google Scholar
9Miyazaki S, Tamaki A, Wakabayashi H, Arai H. Definition, diagnosis, and treatment of respiratory sarcopenia. Curr Opin Clin Nutr Metab Care 2024; 27: 210–218.
10.1097/MCO.0000000000001003
CAS PubMed Web of Science® Google Scholar
10Cruz-Jentoft AJ, Bahat G, Bauer J et al. Sarcopenia: revised European consensus on definition and diagnosis. Age Ageing 2019; 48: 16–31.
10.1093/ageing/afy169
PubMed Web of Science® Google Scholar
11Chen LK, Woo J, Assantachai P et al. Asian working group for sarcopenia: 2019 consensus update on sarcopenia diagnosis and treatment. J Am Med Dir Assoc 2020; 21: 300–307.e2.
10.1016/j.jamda.2019.12.012
PubMed Web of Science® Google Scholar
12Ryu JY, Kim M, Kim KS, Kim S, Won CW. Chair stand test as a proxy for physical performance and muscle strength in sarcopenia diagnosis: the Korean frailty and aging cohort study. Aging Clin Exp Res 2022; 34: 2449–2456.
10.1007/s40520-022-02172-2
PubMed Web of Science® Google Scholar
13Yee XS, Ng YS, Allen JC et al. Performance on sit-to-stand tests in relation to measures of functional fitness and sarcopenia diagnosis in community-dwelling older adults. Eur Rev Aging Phys Act 2021; 18: 1.
10.1186/s11556-020-00255-5
PubMed Web of Science® Google Scholar
14Kera T, Kawai H, Yoshida H et al. Classification of frailty using the Kihon checklist: a cluster analysis of older adults in urban areas. Geriatr Gerontol Int 2017; 17: 69–77.
10.1111/ggi.12676
PubMed Web of Science® Google Scholar
15Sasaki H, Nakamura M, Kida K, Kanbe S, Takahashi K, Fujimura M. The spirometry and arterial blood gas partial pressure reference value in Japanese adult people. Nihon Kokyuki Gakkai Zasshi 2001; 39: 1–17.
Google Scholar
16 Pulmonary physiology task force. Japanese standard value of pulmonary function. Nihon Kyobu Shikkan Gakkai Zasshi 1993; 31.
Google Scholar
17Suzuki M, Teramoto S, Sudo E et al. Age-related changes in static maximal inspiratory and expiratory pressures. Nihon Kyobu Shikkan Gakkai Zasshi 1997; 35: 1305–1311.
CAS PubMed Google Scholar
18Graham BL, Steenbruggen I, Miller MR et al. Standardization of spirometry 2019 update. An official American Thoracic Society and European Respiratory Society technical statement. Am J Respir Crit Care Med 2019; 200: e70–e88.
10.1164/rccm.201908-1590ST
PubMed Web of Science® Google Scholar
19 American Thoracic Society, European Respiratory Society, European Respiratory Society. ATS/ERS statement on respiratory muscle testing. Am J Respir Crit Care Med 2002; 166: 518–624.
10.1164/rccm.166.4.518
PubMed Web of Science® Google Scholar
20Morisawa T, Kunieda Y, Koyama S et al. The relationship between sarcopenia and respiratory muscle weakness in community-dwelling older adults. Int J Environ Res Public Health 2021; 18: 13257.
10.3390/ijerph182413257
PubMed Web of Science® Google Scholar
21Sriboonreung T, Leelarungrayub J, Yankai A, Puntumetakul R. Correlation and predicted equations of MIP/MEP from the pulmonary function, demographics and anthropometrics in healthy Thai participants aged 19 to 50 years. Clin Med Insights Circ Respir Pulm Med 2021; 15: 11795484211004494.
10.1177/11795484211004494
Web of Science® Google Scholar
22Marco E, Sanchez-Rodriguez D, López-Escobar J et al. Is peak expiratory flow an accurate sarcopenia screening tool in older patients referred to respiratory rehabilitation? Eur Geriatr Med 2020; 11: 297–306.
10.1007/s41999-019-00286-x
PubMed Google Scholar
23 R Core Team. R: A language and environment for statistical computing. Version 4.2.2. Vienna, Austria: R Foundation for Statistical Computing; 2013.
Google Scholar
24Black LF, Hyatt RE. Maximal respiratory pressures: normal values and relationship to age and sex. Am Rev Respir Dis 1969; 99: 696–702.
CAS PubMed Web of Science® Google Scholar
25Park JH, Kang SW, Lee SC, Choi WA, Kim DH. How respiratory muscle strength correlates with cough capacity in patients with respiratory muscle weakness. Yonsei Med J 2010; 51: 392–397.
10.3349/ymj.2010.51.3.392
PubMed Web of Science® Google Scholar
26Héritier F, Rahm F, Pasche P, Fitting JW. Sniff nasal inspiratory pressure. A noninvasive assessment of inspiratory muscle strength. Am J Respir Crit Care Med 1994; 150: 1678–1683.
10.1164/ajrccm.150.6.7952632
CAS PubMed Web of Science® Google Scholar
27Sutil DV, Parentoni AN, Da Costa Teixeira LA et al. Prevalence of sarcopenia in older women and level of agreement between the diagnostic instruments proposed by the European working group on sarcopenia in older people 2 (EWGSOP2). BMC Musculoskelet Disord 2023; 24: 182.
10.1186/s12891-023-06287-z
PubMed Web of Science® Google Scholar
28Cook CD, Mead J, Orzalesi MM. Static volume-pressure characteristics of the respiratory system during maximal efforts. J Appl Physiol 1964; 19: 1016–1022.
10.1152/jappl.1964.19.5.1016
CAS PubMed Web of Science® Google Scholar
29Kubota M, Kobayashi H, Quanjer PH et al. Reference values for spirometry, including vital capacity, in Japanese adults calculated with the LMS method and compared with previous values. Respir Investig 2014; 52: 242–250.
10.1016/j.resinv.2014.03.003
PubMed Google Scholar
30Tian XY, Liu CH, Wang DX et al. Spirometric reference equations for elderly Chinese in Jinan aged 60-84 years. Chin Med J 2018; 131: 1016–1022.
10.4103/0366-6999.227840
PubMed Web of Science® Google Scholar

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Comparative analysis of the maximal respiratory pressure and peak expiratory flow rate in diagnosing probable respiratory sarcopenia – The Otassha Study

Abstract

Aim

Methods

Results

Conclusions

Open Research

Data Availability Statement

Supporting Information

References

References

Information

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Comparative analysis of the maximal respiratory pressure and peak expiratory flow rate in diagnosing probable respiratory sarcopenia – The Otassha Study

Abstract

Aim

Methods

Results

Conclusions

Open Research

Data Availability Statement

Supporting Information

References

References

Related

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