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Association between cardiorespiratory fitness and handgrip strength with age-related macular degeneration: a population-based study
  1. Andreas Katsimpris1,
  2. Clemens Jürgens2,
  3. Lisa Lüdtke3,
  4. Bahls Martin4,5,
  5. Till Ittermann2,
  6. Sven Gläser4,
  7. Marcus Dörr4,5,
  8. Ralf Ewert4,
  9. Konstantinos Volaklis1,6,
  10. Stephan B. Felix4,5,
  11. Frank Tost3,
  12. Henry Völzke2,5,
  13. Christa Meisinger1,7,
  14. Sebastian E. Baumeister1,7
  1. 1 Chair of Epidemiology, UNIKA-T, Ludwig-Maximilians-Universität München, Munich, Germany
  2. 2 Institute for Community Medicine, University Medicine, Greifswald, Germany
  3. 3 Department of Ophthalmology, University Medicine Greifswald, Greifswald, Germany
  4. 4 Cardiology, Intensive Care, Pulmonary Medicine and Infectious Diseases Department, Greifswald University Hospital Clinic and Polyclinic of Internal Medicine B, Greifswald, Germany
  5. 5 Partner Site Greifswald, German Center for Cardiovascular Research (DZHK), Greifswald, Germany
  6. 6 Department of Prevention and Sports Medicine, Technical University of Munich, Munich, Germany
  7. 7 Independent Research Group Clinical Epidemiology, Helmholtz Center Munich German Research Center for Environmental Health, Neuherberg, Germany
  1. Correspondence to Andreas Katsimpris, Chair of Epidemiology, Ludwig-Maximilians-Universität München, UNIKA-T Augsburg, Neusässer Str. 47, Augsburg 86156, Germany; katsimprisandreas{at}


Aim To assess whether cardiorespiratory fitness (CRF) and handgrip strength, two objective markers of physical fitness, are associated with age-related macular degeneration (AMD).

Methods We analysed cross-sectional data from the population-based Study of Health in Pomerania (2008–2012) including 1173 adult men and women aged 20–79 years. Fundus photography of the central retina was recorded with a non-mydriatic camera, and images were graded according to an established clinical AMD classification scale by an experienced reader. CRF was measured using peak oxygen uptake (peakVO2), oxygen uptake at the anaerobic threshold (VO2@AT), and maximum power output (Wmax) from standardised cardiopulmonary exercise testing on a bicycle ergometer according to a modified Jones protocol. Handgrip strength was assessed using a handheld dynamometer. Adjusted prevalence ratios (PR) for the associations of peakVO2, VO2@AT, Wmax and handgrip strength with AMD were derived from multivariable Poisson regression models.

Results PeakVO2, VO2@AT, Wmax and handgrip strength were not associated with AMD. Adjusted PR for AMD associated with a 1-SD increment in peakVO2, VO2@AT, Wmax and handgrip strength were 1.05 (95% CI 0.82 to 1.34), 0.96 (95% CI 0.78 to 1.18), 1.10 (95% CI 0.86 to 1.41) and 1.01 (95% CI 0.79 to 1.30), respectively. These associations were not modified by age, sex, smoking, body mass index and diabetes. Estimates in sensitivity analysis for confounding, selection bias and missing data were similar.

Conclusion In our study, CRF and handgrip strength were not associated with AMD. Nevertheless, longitudinal studies with bigger sample sizes are needed to furtherly examine these associations.

  • Macula
  • Epidemiology
  • Degeneration

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  • Contributors AK, CJ, CM and SEB drafted the manuscript. CJ and LL were involved in data collection and AMD grading. SEB, AK and TI analysed the data. MB, TI, SG, MD, RE, KV, SBF, FT, LL and HV critical revised the manuscript for important intellectual content. All authors provided administrative, technical or material support.

  • Funding The Study of Health in Pomerania is part of the Community Medicine Research Network of the University Medicine Greifswald, which was funded by the German Federal Ministry for Education and Research (BMBF, Grants 01ZZ0403, 01ZZ0103, 01GI0883), the Ministry for Education, Research and Cultural Affairs, as well as the Ministry for Social Affairs of the State Mecklenburg-West Pomerania.

  • Competing interests None declared.

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

  • Data availability statement No data are available.

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

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