Original Research
Handgrip strength is associated with anthropometrics variables and sex in preschool children: A cross sectional study providing reference values

https://doi.org/10.1016/j.ptsp.2017.04.002Get rights and content

Highlights

  • Handgrip strength is a feasible and highly reliable test in preschool children.

  • Handgrip strength increase with age in preschoolers.

  • The boys are generally stronger than the girls.

  • The anthropometric measures correlate positively with handgrip strength.

  • This study provides references values for HS in preschoolers.

Abstract

Objective

The purpose of this study was to examine the influence of age, sex and anthropometric variables in handgrip strength and to determine norm-referenced values for preschool children.

Design

Cross-sectional study.

Setting

Schools.

Participants

A total of 1215 children, aged 3–6 years (590 girls and 625 boys).

Intervention

Not applicable.

Main outcome measures

Handgrip strength (HS), measured by the CAMRY hydraulic hand dynamometer (EH101; Camry, Guangdong Province, China).

Results

Boys exhibited a greater performance than girls in the 4 and 5 years age groups, but no significant differences were found at 3 and 6 years. In relation to growth, HS performance was greater with increased age. The Pearson correlation analysis showed significant correlations between HS and body mass (r = 0.354, p < 0.001), body height (r = 0.352, p < 0.001), body mass index (r = 0.164, p < 0.001) and waist circumference (r = 0.118, p < 0.001).

Conclusion

This study provides references values for muscular strength assessment by an HS test carried out on a large sample of preschoolers in relation to age and sex. Additionally, some differences in HS performance were found according to sex.

Introduction

The preschool age is characterised by significant changes in the acquisition of locomotor skills and nervous system maturation (Tanaka, Hikihara, Ohkawara, & Tanaka, 2012). The development of muscular strength in children and adolescents brings health benefits (Smith et al., 2014). In line with this, Ortega, Ruiz, Castillo, and Sjöström (2008) showed that physical fitness level is a potent biomarker of health from an early age. Therefore, a fitness test provides important information on children's health, although is not often used in schools (Castro-Piñero et al., 2009). Specifically, in preschoolers muscular strength contributes to skeletal development, while sedentary behaviour negatively affects bone health (Herrmann et al., 2015). In adolescents, muscular fitness is negatively associated with a clustered metabolic risk independent of cardiorespiratory fitness (Artero et al., 2011). Furthermore, muscular strength has been identified for the first time as an independent and powerful predictor of better insulin sensitivity in children (Benson, Torode, & Fiatarone Singh, 2006). A low level of muscular strength in adolescence, as measured by knee extension and handgrip strength (HS), is associated with all-cause premature mortality; other risk factors include abnormal body mass index (BMI) and blood pressure (Ortega, Silventoinen, Tynelius, & Rasmussen, 2012).

Handgrip strength is outstanding as a measure of general health and is often estimated in screenings of normal motor function (Häger-Ross & Rösblad, 2002). In particular, HS is an indicator of nutritional level (Schlüssel, Anjos, & Kac, 2008), which correlates to morbidity and mortality in the young (Montalcini et al., 2016). Several studies have shown the importance of the use of HS tests in clinical practice and fitness control in children (Latorre-Román et al., 2014, Marrodán Serrano et al., 2009, Martinez-Tellez et al., 2015, Rauch et al., 2002a).

Handgrip strength is a simple, inexpensive, reliable, and valid indicator of upper-body muscular strength. The handgrip test seems to be the most practicable way of assessing upper-body strength in children; moreover, handgrip scores can be used to analyse age- and sex-related variation in muscular strength (Saint-Maurice, Laurson, Karsai, Kaj, & Csanyi, 2015). However, it is not often used in preschool children (Cohen et al., 2010, Ploegmakers et al., 2013). There are currently limited studies that have analysed correlates of physical fitness associated with growth and maturity (Malina & Katzmarzyk, 2006), particularly regarding HS in preschool children, although a recent study showed an association of HS with BMI in preschool children (Martinez-Tellez et al., 2015).

Currently, different authors propose reference values for HS in different populations (Budziareck et al., 2008, Cohen et al., 2010, Hogrel, 2015, Ploegmakers et al., 2013); however, to our knowledge, there are no reference values for preschool children. Low values of HS in childhood may have negative health implications for later life (Cohen et al., 2010, Ortega et al., 2012). From a public health perspective, population-specific normative data may be useful to identify those with low HS. At present, there is no normative reference available regarding HS for preschool-age Spanish children. Therefore, the main purpose of this study was to examine the influence of age, sex and anthropometric variables in HS and to determine norm-referenced values for preschool children. A second objective was to evaluate the reliability of the HS test in preschool children.

Section snippets

Study design

This cross-sectional study analysed HS in a cohort of healthy preschool children to generate normative values.

Participants

A total of 1215 children, aged 3–6 years, participated in this study (mean age = 4.32 ± 1.05 years, BMI = 19.59 ± 4.56 kg/m2, 590 girls and 625 boys), recruited from 30 schools located in southern Spain (Andalusia) from the Jaen, Cordoba and Granada provinces. The sample is therefore one of convenience, taken from urban and rural areas. Inclusion criteria comprised schooling in early

Materials and testing

Body mass (kg) was measured using a weighing scale (Seca 899, Hamburg, Germany) and body height (cm) was measured with a stadiometer (Seca 222, Hamburg, Germany). The body mass index was calculated by dividing body mass (kg) by body height2 (in metres). Waist circumference was measured at the umbilical location by using a non-elastic Ergonomic Circumference Measuring Tape (Seca 201, Germany; range 0–150 cm; accuracy: 1 mm). All measures were taken twice, and the average was used for analysis.

Results

In the test-retest analysis, the following descriptive results were obtained in the pretest (mean, SD) = 6.46 ± 2.09 kg, retest (mean, SD) = 6.29 ± 1.97 kg, p ≥ 0.05, and an ICC = 0.969 (95% confidence interval (CI) = 0.950–0.980) was found. The Bland-Altman graph showed limits of agreement (2 SD) of 1.49 and −1.26 kg, and the mean of the differences was equal to 0.11 ± 0.69 kg (Fig. 1).

Table 1 shows the anthropometric characteristics and HS performance in relation to sex. Boys exhibited a

Discussion

The main purpose of this study was to examine the influence of age, sex and anthropometric variables in HS and to determine norm-referenced values for preschool children. A second objective was to evaluate the reliability of the HS test in preschool children.

To our knowledge, this is the first study to provide reference values of HS in southern Spanish preschool children. The main findings of this study show that HS, as expected, increased with age, that boys are generally stronger than girls

Ethical statement

The study was completed in accordance with the norms of the Declaration of Helsinki (2013 version) and following the directives of the European Union on Good Clinical Practice (111/3976/88 of July, 1990), as specified in the Spanish legal framework for human clinical research (Royal Decree 561/1993 on clinical essays). The study was approved by the Ethics Committee of the University of Jaen (Spain) (Reference: CEIH 120215-1).

Funding source declaration

The authors declare there is no funding or research grants (and their source) received in the course of study, research or assembly of the manuscript.

Acknowledgements

We gratefully thank all the schools of Andalusia who have collaborated in this study.

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