Normative reference values for strength and flexibility of 1,000 children and adults

Abstract

Objective: To establish reference values for isometric strength of 12 muscle groups and flexibility of 13 joint movements in 1,000 children and adults and investigate the influence of demographic and anthropometric factors.Methods: A standardized reliable protocol of hand-held and fixed dynamometry for isometric strength of ankle, knee, hip, elbow, and shoulder musculature as well as goniometry for flexibility of the ankle, knee, hip, elbow, shoulder, and cervical spine was performed in an observational study investigating 1,000 healthy male and female participants aged 3-101 years. Correlation and multiple regression analyses were performed to identify factors independently associated with strength and flexibility of children, adolescents, adults, and older adults. Results:Normative reference values of 25 strength and flexibility measures were generated.Strong linear correlations between age and strength were identified in the first 2 decades of life. Muscle strength significantly decreased with age in older adults. Regression modeling identified increasing height as the most significant predictor of strength in children, higher body mass in adolescents, and male sex in adults and older adults. Joint flexibility gradually decreased with age, with little sex difference. Waist circumference was a significant predictor of variability in joint flexibility in adolescents, adults, and older adults. Conclusions:Reference values and associated age-and sex-stratified z scores generated from this study can be used to determine the presence and extent of impairments associated with neuromuscular and other neurologic disorders, monitor disease progression over time in natural history studies, and evaluate the effect of new treatments in clinical trials. Neurology ® 2017;88:36-43Meaningful, reliable, and sensitive outcome measures are required to monitor treatment and progression of neuromuscular and other neurologic disorders. While there have been substantial advances in the understanding of the pathogenesis and natural history of many neuromuscular disorders, the identification and development of new outcome measures that best reflect the efficacy of specific treatments have not advanced at the same rate. 1 Establishing valid and responsive outcome measures is a priority for the field. 2 To assist in the development of new outcome measures, normative reference values generated from large populations across the lifespan using standardized methods are required. Normative reference values can be utilized to generate z scores, which can be used in multicenter studies to improve outcome measure precision and responsiveness.Muscle weakness and joint contractures predispose to numerous pathologies requiring intervention. Reference data play an important role in identifying and quantifying these impairments and evaluating the effectiveness of interventions. Currently, few comprehensive datasets detail the normal variation of active range of motion in healthy individuals and are limited by the number of joints assessed, 3...

Fifteen‐year longitudinal follow‐up of a patient with severe early‐onset Charcot‐Marie‐Tooth disease type 2A

“…Interestingly and somewhat surprisingly, knee extension and flexion strength slowly declined over the period of follow‐up. This finding is in stark contrast to longitudinal normative data, which show a greater than threefold and fourfold increase in knee extension and flexion strength, respectively, between the age ranges of 3–9 and 10–19 years of age . While the changes in proximal leg strength need to be validated in additional CMT2A patients, these data suggest that quantitative quadriceps and hamstring strength measurements may be a sensitive readout for disease progression in children with CMT2A.…”

Myalgic Encephalomyelitis (ME) or What? An Operational Definition

“…This implies that muscle fatigability/prolonged muscle weakness after exertion is a discriminative feature of ME. Long-lasting muscle weakness after exertion can be validated objectively by measuring muscle power of the arms, hands [24,25], legs [26,27], etc., during repeated muscle contractions on two consecutive days using dynamometers [28,29]. …”

Clinimetric properties of the one‐leg sit‐to‐stand test in examining unilateral lower limb muscle strength among young adults

“…Therefore, the test could be used within 2 weeks of injury for LE muscle strength assessment before return to play and as well as to monitor changes in the LE muscle strength in chronic injuries. For any new clinical outcome measures and clinical tests, it is crucial to establish normative reference values as it helps clinicians to improve the precision and responsiveness of the clinical test 20 . Therefore, future study should be carried out to establish the normative reference values of one‐leg STS test as it might assist the clinicians to apply the test effectively in clinical practice.…”