In this group of patients AT and peak VO2 were only weakly related to HGS. This is perhaps surprising given previous findings suggesting that HGS is associated with loss of physical function. This negative finding may be due to inadequate sample size, effort dependence of VO2 peak, poor correlation between upper and lower limb muscle mass (CPET at our centre is performed on a cycle).
Strengths of this study include standardised testing, a range of age, sex and surgical specialities. Weaknesses are that no patient centred or clinical endpoints were investigated, and potential bias due to selective referrals and retrospective nature of the study.
These results reinforce that there is unlikely to be any universally applicable, reliable test to inform perioperative risk, as concordance of different markers of ‘fitness’ is limited. Hand grip strength, however, may be useful in combination with CPET to help guide personalised, shared decision making.