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 Table of Contents  
ORIGINAL ARTICLE
Year : 2022  |  Volume : 9  |  Issue : 1  |  Page : 41-44

Association of hand grip muscle strength and endurance with pulmonary function tests in healthy young adults


Department of Physiology, Gauhati Medical College and Hospital, Guwahati, Assam, India

Date of Submission02-Jul-2020
Date of Decision30-Sep-2020
Date of Acceptance08-Jun-2021
Date of Web Publication18-Oct-2022

Correspondence Address:
Jolly Bhattacharjya
Department of Physiology, Gauhati Medical College and Hospital , Guwahati - 781 032, Assam
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/cjhr.cjhr_85_20

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  Abstract 


Introduction: Modern society is creating a severe threat to the health. Such as physical inactivity leading to muscle weakness, air pollution causing respiratory distress etc. But the relationship between hand grip muscle strength (HGS) and pulmonary function is not clear. Hence, the present study was designed to investigate is there any association of handgrip muscle strength and endurance with pulmonary function test (PFT) parameters in healthy young adults. Materials and Methods: In this cross-sectional study, 80 healthy volunteers of 18–21 years of age had participated. PFT was done using portable spirometer. For measurement of muscle strength and endurance, handgrip dynamometer was used. Statistical analysis was done using SPSS 26 software. Mean was calculated for the general characteristics. Pearson correlation coefficient was calculated to analyze the association of handgrip muscle strength and various indices of pulmonary function. Results: In this study (47), 58.8% were male and (33) 41.3% were female. Muscle strength, endurance, forced vital capacity (FVC), forced expiratory flow in 1 s (FEV1), peak expiratory flow rate (PEFR) were significantly higher in males than females. There were significantly positive correlation of handgrip muscle strength with FVC (r = 0.522**, P = 0.000) and FEV1 (r = 0.486**, P = 0.000). Muscle endurance was significantly positively correlated with FVC (r = 0.397**, P = 0.000), FEV1 (r = 0.438**, P = 0.000) and PEFR (r = 0.221*, P = 0.049). Conclusions: Hence, it can be concluded that there is a positive correlation of handgrip muscle strength and endurance with pulmonary function. Hence, HGS can also be used to predict pulmonary function.

Keywords: Handgrip dynamometer, handgrip muscle strength (HGS), pulmonary function test


How to cite this article:
Bhattacharjya J. Association of hand grip muscle strength and endurance with pulmonary function tests in healthy young adults. CHRISMED J Health Res 2022;9:41-4

How to cite this URL:
Bhattacharjya J. Association of hand grip muscle strength and endurance with pulmonary function tests in healthy young adults. CHRISMED J Health Res [serial online] 2022 [cited 2022 Dec 8];9:41-4. Available from: https://www.cjhr.org/text.asp?2022/9/1/41/358823




  Introduction Top


Urbanization and modernization have improved our quality of life but at the same time, it is creating many problems that are threat to the health. One such problem caused by the development of modern society is the reduction in physical activity across all generations throughout the world. Worldwide, 31·1% (95% confidence interval 30·9–31·2) of young adults are physically inactive, higher in women than men.[1] Time spent in physical activity has decreased significantly. Excessive academic pressure, physical environment in neighbourhoods, influence of parents, more time spent using visual media are the leading causes of reduction in physical activity.[2] Physical inactivity leads to obesity, muscle weakness, and many other health ailments. Thus, most of the young generation of our modern society are showing gradually decreasing physical fitness. Again, studies with inconsistent results showed that physical activity is positively associated with lung function growth.[3] Another major problem due to urbanization in developing countries is air pollution. Air pollution is a major cause of respiratory diseases such as asthma and allergic diseases.[4],[5] These respiratory diseases may further decrease exercise capacity and contribute to loss in muscle strength and power.

Handgrip strength (HGS), a simple bedside tool test, is portable, relatively inexpensive, and a reliable measurement of muscular strength. It can be used as a predictor of postoperative complications and is associated with mortality, disability, and other health-related complications among middle-aged and older people.[6],[7],[8]

The Global Initiative for Chronic Obstructive Lung Disease has approved spirometry as a noninvasive tool in evaluating the respiratory status of an individual.[9] These tests (spirometric indices) are (i) forced expiratory flow in 1 s (FEV1), (ii) forced vital capacity (FVC), and (iii) peak expiratory flow rate (PEFR); they involve forceful exhalation of air from the lungs and standard practices done during health examination in occupational health assessment and sports sciences.[10]

Hence, studies are there on association of HGS and obstructive lung diseases and also on association of muscle strength and pulmonary function in old age.[11],[12],[13] However, very few studies are there to find the association of HGS and pulmonary function test (PFT) in healthy young adults and with inconsistent result. And to the best of our knowledge, no such studies are done till now to assess the relationship of handgrip muscle strength with pulmonary function in healthy young adults in this part of the globe. Hence, this study was aimed, to investigate the correlation of handgrip muscle strength and endurance with PFT in healthy young adults. We also tried to investigate; can handgrip dynamometry be used as a screening procedure to predict the requirement of an extensive evaluation of pulmonary function.


  Materials and Methods Top


Institutional ethical clearance was taken for this cross-sectional study which was done in the Department of Physiology.

We had randomly selected 80 healthy volunteers of both sexes which were of 18–21 years of age, after taking informed written voluntary consent. Smokers, drinkers, athletes, who used to do regular minimum recommended physical activity, and persons having major health ailment were excluded from this study.[14] Parameters were usually recorded in the first half of the day between 10 am to 12 noon to avoid the effect of heavy meal on the parameters.

Socio-demographic parameters such as age, gender, weight, height, and body mass index of the participants were recorded at the start of the study, using questionnaires.

For pulmonary function FVC, FEV1, FEV1/FVC ratio, and PEFR were measured using portable spirometer.[15] Disposable mouthpieces were used for each participant. The participant inhaled maximally through the nose until the lungs were full. Afterward, the participant placed the spirometer through the disposable mouthpiece in his/her mouth, with lips sealed tightly around the mouthpiece while holding the lungs full. The participant was instructed to exhale forcefully as long as possible into the spirometer until no air could be exhaled.

For measurement of muscle strength, handgrip dynamometer (INCO India Ltd., Ambala) was used. In standing posture, the dominant arm was positioned at the side of the body, the dynamometer was held with elbow flexed at 90° and they were asked to press the handle of the dynamometer with maximum strength. The maximal voluntary contraction was sustained for at least 3 s and it was recorded as the handgrip strength in kilograms (kg). Three readings were taken with a gap of 30 s and the maximum reading was taken for analysis.[16] The handgrip endurance was determined by asking the subject to maintain 1/3rd of maximal voluntary contraction for as long as he/she could and the time was recorded in seconds by using a stopwatch.[17] The results of spirometric and HGS readings were tabulated and statistical analysis was done to find out any association between the two variables.

Statistical analysis was done using SPSS software 26 version (IBM, Bangaluru, Karnatak, India). Mean was calculated for the general characteristics. Independent Student's t-test was done to compare the variables. Pearson correlation coefficient was calculated to analyze the association of handgrip muscle strength and various indices of pulmonary function. Linear regression test was done to explore the nature of relationship.


  Results Top


In this study, out of the total 80 participants of age group 18–21 years (47), 58.8% were male and (33) 41.3% were female. [Table 1] shows the general characteristics of the participants. As shown in [Table 1], it was observed that mean handgrip muscle strength (in kg) was more in male than female and was 27.15 ± 6.99 and 12.12 ± 10.30 respectively which was statistically significant. It was also seen that mean endurance (in sec) was also statistically significantly higher in male than female the values were 42.49 ± 30.04 and 16.15 ± 9.808, respectively. PFT indices like FVC (in L) (male = 2.699 ± 2.698, female = 1.766 ± 0.4824), FEV1 (in L) (male = 2.696 ± 0.7133, female = 1.621 ± 0.4884) and PEFR (in L/s) (male = 11.57 ± 1.767, female = 2.929 ± 1.324) were significantly higher in male than female. Although the FEV1/FVC ratio is greater in female than male, it is statistically not significant as P > 0.05.
Table 1: Comparing general characteristics of the participants according to sex

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Pearson correlation coefficient was calculated to find the association between hand grip strength and endurance with the various indices of PFT, which is shown in [Table 2]. It showed significant positive correlation of hand grip muscle strength (HGS) with FVC (r = 0.522**, P = 0.000), FEV1 (r = 0.486**, P = 0.000) and significant positive correlation of hand grip muscle endurance with FVC (r = 0.397**, P = 0.000), FEV1 (r = 0.438**, P = 0.000), and PEFR (r = 0.221*, P = 0.049). Results did not show any significant correlation of FEV1/FVC ratio with hand grip muscle strength and endurance.
Table 2: Correlation of handgrip muscle strength and endurance with pulmonary function test parameters

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  Discussion Top


This study was carried out to investigate the association of handgrip muscle strength and endurance with PFT in healthy young adults. In this study, we found that handgrip muscle strength, endurance, and pulmonary function indices (FVC, FEV1, PEFR) were higher in male than female. This finding was the same as the study done by Mgbemena et al. where their results also showed that the mean values of HGS and lung function indices were higher in males than that of females.[18] This finding may be attributed to difference in body mass and built of males and females due to differences in hormonal levels in both genders.

We also found a significant positive correlation of handgrip muscle strength with FVC and FEV1. So with decrease muscle strength there is decrease in pulmonary function which is the same as the study by Bernard et al.[12] They also showed a significant correlation between upper arm quadriceps muscle strength and FEV1% of predictive value. Our results were also consistent with previous studies, supporting the conclusion that better respiratory function is associated with greater HGS.[13],[19],[20],[21],[22]

The interrelationships between HGS and pulmonary functions in previous studies had shown inconsistent results also; a study had shown that, peripheral muscle strength be associated with maximum inspiratory pressure and peak cough flow but not with maximum expiratory pressure or any other spirometric parameters.[23] Whereas others have shown lower HGS in patients with obstructive lung disease.[24],[25] This discrepancy probably resulted from differences in skeletal muscles under investigation, investigating methods, environmental factor, and the age and health status of the population under study.

Our study also showed a significant positive correlation of muscle endurance with FVC, FEV1 and PEFR. But we did not get any reference consistent with this result of muscle endurance. May be this is first ever study establishing relationship of muscle endurance with pulmonary function.

Overall, simplicity of measurement, portability, low cost, and prognostic value make HGS an attractive and important means of evaluating an individual's overall health in clinical or epidemiological settings.[26],[27]

Some studies reported that HGS is a significant predictor of pulmonary function in healthy young adults, and some concluded that strength training might improve lung health in adolescents and renal transplant recipients.[18],[20],[28]

Taking into consideration of every aspect, we can conclude from our study that there is significant positive association of handgrip muscle strength and endurance with PFTs. So HGS, which is noninvasive and inexpensive, can be used as first test to predict the patients who need extensive pulmonary function or exercise capacity tests especially in remote areas where expensive equipment are not available.

Acknowledgment

I would like to thank Head of the Department for allowing me to do the project, laboratory technicians of my department for helping me in carrying out the tests, statistician Arup Sarma for helping me in the statistical analysis, and the volunteers for participating in this project.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Hallal PC, Andersen LB, Bull FC, Guthold R, Haskell W, Ekelund U, et al. Global physical activity levels: Surveillance progress, pitfalls, and prospects. Lancet 2012;380:247-57.  Back to cited text no. 1
    
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Ji J, Wang SQ, Liu YJ, He QQ. Physical activity and lung function growth in a cohort of Chinese school children: A prospective study. PLoS One 2013;8:e66098.  Back to cited text no. 3
    
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Bohannon RW. Dynamometer measurements of hand-grip strength predict multiple outcomes. Percept Mot Skills 2001;93:323-8.  Back to cited text no. 6
    
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Bohannon RW. Hand-grip dynamometry predicts future outcomes in aging adults. J Geriatr Phys Ther 2008;31:3-10.  Back to cited text no. 7
    
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Puhan MA, Siebeling L, Zoller M, Muggensturm P, ter Riet G. Simple functional performance tests and mortality in COPD. Eur Respir J 2013;42:956-63.  Back to cited text no. 8
    
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The Global Initiative for Chronic Obstructive Lung Disease (GOLD); Global strategies for the diagnosis, management and prevention of chronic obstructive pulmonary disease; 2018 report.  Back to cited text no. 9
    
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Gosselink R, Troosters T, Decramer M. Peripheral muscle weakness contributes to exercise limitation in COPD. Am J Respir Crit Care Med 1996;153:976-80.  Back to cited text no. 11
    
12.
Bernard S, LeBlanc P, Whittom F, Carrier G, Jobin J, Belleau R, et al. Peripheral muscle weakness in patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med 1998;158:629-34.  Back to cited text no. 12
    
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Sillanpää E, Stenroth L, Bijlsma AY, Rantanen T, McPhee JS, Maden-Wilkinson TM, et al. Associations between muscle strength, spirometric pulmonary function and mobility in healthy older adults. Age (Dordr) 2014;36:9667.  Back to cited text no. 13
    
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Haskell WL, Lee IM, Pate RR, Powell KE, Blair SN, Franklin BA, et al. Physical activity and public health: Updated recommendation for adults from the American College of Sports Medicine and the American Heart Association. Med Sci Sports Exerc 2007;39:1423-34.  Back to cited text no. 14
    
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Miller MR, Hankinson J, Brusasco V, Burgos F, Casaburi R, Coates A, et al. ATS/ERS Task Force: Standardisation of spirometry. Eur Respir J 2005;26:319-38.  Back to cited text no. 15
    
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Roberts HC, Denison HJ, Martin HJ, Patel HP, Syddall H, Cooper C, et al. A review of the measurement of grip strength in clinical and epidemiological studies: Towards a standardised approach. Age Ageing 2011;40:423-9.  Back to cited text no. 16
    
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Bandyopadhyay A. Body composition and hand grip strength in male brick-field workers. Malays J Med Sci 2008;15:31-6.  Back to cited text no. 17
    
18.
Mgbemena NC, Aweto HA, Tella BA, Emeto TI, Malau-Aduli BS. Prediction of lung function using handgrip strength in healthy young adults. Physiol Rep 2019;7:e13960.  Back to cited text no. 18
    
19.
Efstathiou ID, Mavrou IP, Grigoriadis KE. Correlation between maximum inspiratory pressure and hand-grip force in healthy young and middle-age individuals. Respir Care 2016;61:925-9.  Back to cited text no. 19
    
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Smith MP, Standl M, Berdel D, von Berg A, Bauer CP, Schikowski T, et al. Handgrip strength is associated with improved spirometry in adolescents. PLoS One 2018;13:e0194560.  Back to cited text no. 20
    
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Smith MP, Müller J, Neidenbach R, Ewert P, Hager A. Better lung function with increased handgrip strength, as well as maximum oxygen uptake, in congenital heart disease across the lifespan. Eur J Prev Cardiol 2019;26:492-501.  Back to cited text no. 21
    
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Bahat G, Tufan A, Ozkaya H, Tufan F, Akpinar TS, Akin S, et al. Relation between hand grip strength, respiratory muscle strength and spirometric measures in male nursing home residents. Aging Male 2014;17:136-40.  Back to cited text no. 22
    
23.
Bahat G, Tufan A, Ozkaya H, Tufan F, Akpinar TS, Akin S, et al. Relation between hand grip strength, respiratory muscle strength and spirometric measures in male nursing home residents. Aging Male 2014;17:136-40. doi: 10.3109/13685538.2014.936001.  Back to cited text no. 23
    
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Strandkvist VJ, Backman H, Röding J, Stridsman C, Lindberg A. Hand grip strength is associated with forced expiratory volume in 1 second among subjects with COPD: Report from a population-based cohort study. Int J Chron Obstruct Pulmon Dis 2016;11:2527-34.  Back to cited text no. 24
    
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Leong DP, Teo KK, Rangarajan S, Kutty VR, Lanas F, Hui C, et al. Reference ranges of handgrip strength from 125,462 healthy adults in 21 countries: A prospective urban rural epidemiologic (PURE) study. J Cachexia Sarcopenia Muscle 2016;7:535-46.  Back to cited text no. 26
    
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    Tables

  [Table 1], [Table 2]



 

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