Hand grip strength: Reference values for adults and elderly people of Rio Branco, Acre, Brazil

RESEARCH ARTICLE Hand grip strength: Reference values for adults and elderly people of Rio Branco, Acre, Brazil Cledir Araújo Amaral ID1*, Thatiana Lameira Maciel Amaral ID2¤, Gina Torres Rego Monteiro3, Mauricio Teixeira Leite Vasconcellos4, Margareth Crisóstomo Portela5 a1111111111 a1111111111 a1111111111 a1111111111 a1111111111 OPEN ACCESS Citation: Amaral CA, Amaral TLM, Monteiro GTR, Vasconcellos MTL, Portela MC (2019) Hand grip strength: Reference values for adults and elderly people of Rio Branco, Acre, Brazil. PLoS ONE 14 (1): e0211452. https://doi.org/10.1371/journal. pone.0211452 Editor: Fernando C. Wehrmeister, Federal University of Pelotas, BRAZIL Received: April 27, 2018 Accepted: January 15, 2019 Published: January 31, 2019 Copyright: © 2019 Amaral et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Data Availability Statement: All relevant data are within the paper and its Supporting Information files. Funding: Funded by Chamada PPSUS No. 01/2015 —http://www.fapac.ac.gov.br/wps/portal/fapac/ fapac/principal—CAA. Chamada MCTI/CNPQ/MSSCTIE- DECIT n˚. 06/2013—http://cnpq.br/web/ guest/pagina-inicial—GTRM. They funded operating expenses for data collection. Chamada PPSUS No. 01/2013—http://www.fapac.ac.gov.br/ wps/portal/fapac/fapac/principal—TLMA. 1 Federal Institute of Acre, Rio Branco, Acre, Brazil, 2 Center for Health Sciences and Sports, Federal University of Acre, Rio Branco, Acre, Brazil, 3 Department of Epidemiological and Quantitative Methods in Health, National School of Public Health Sergio Arouca, Oswaldo Cruz Foundation, Rio de Janeiro, Rio de Janeiro, Brazil, 4 National School of Statistical Sciences, Brazilian Institute of Geography and Statistics, Rio de Janeiro, Rio de Janeiro, Brazil, 5 Department of Health Administration and Planning, National School of Public Health Sergio Arouca, Oswaldo Cruz Foundation, Rio de Janeiro, Rio de Janeiro, Brazil ¤ Current address: Stricto Sensu Graduate Program in Collective Health, Federal University of Acre, Rio Branco, Acre, Brazil * Abstract Hand grip strength (HGS) is recognized as an important health indicator, but validated reference values that can be applied to the evaluation of individuals in different populations are still lacking. This work aimed to identify correlations between HGS and anthropometric variables and to establish HGS reference values for adult and elderly populations. This is a population-based cross-sectional study considering the subsets of individuals with healthy right or left upper limbs from a sample of 1,609 adults and elderly residents in Rio Branco, Acre, Brazil. Descriptive statistics of anthropometric measures and HGS values at maximum performance based on three measurements of the two hands were obtained, and Pearson correlations between these variables were applied. Percentile distributions were estimated for right and left HGS by sex and age group. Men presented, in general, a maximum HGS 57% higher than women (43.4 kg vs. 27.6 kg), and also higher HGS levels in the different age groups. In both sexes, the highest HGS values were observed in the age group of 30 to 39 years (men, 46.9 kg; women, 29.4 kg), with a subsequent decline. HGS presented a negative correlation with age and a weak to moderate positive correlation with anthropometric variables, among men and women. The median HGS of men was reduced by about 46% between the ages of 30 and 39 years and 80 years and over (right hand, 46.4 to 23.7 kg; left hand, 42.2 to 23.5 kg) and by about 44% in women (right hand, 29.0 to 16.4 kg, left hand, 27.3 to 15.2 kg). The values identified are a reference for HGS behavior among healthy adults and seniors, although they do not discriminate individuals with specific health conditions. They can be used in rehabilitation programs and subsidize future studies aimed at exploring their potential application in the evaluation of the health condition of adults and elderly individuals. PLOS ONE | https://doi.org/10.1371/journal.pone.0211452 January 31, 2019 1 / 13 Hand grip strength: Reference values for adults and elderly people Competing interests: The authors have declared that no competing interests exist. Introduction Hand grip strength (HGS) is used clinically in the rehabilitation area [1,2] and has been recommended as a basic measure in the determination of musculoskeletal function, as well as of weakness and disability [3–5]. The HGS, measured by manual dynamometry, produces a measure of isometric strength that allows identifying not only muscle weakness of the upper limb, but also providing an indicative of overall strength, since it reflects the strength of the lower limbs [6]. This gives it an important role in the evaluation of functionality [1]. Manual dynamometry is a relatively simple, fast, inexpensive and non-invasive test; thus HGS is considered a good health marker [7]. HGS is influenced by age, sex, anthropometric variables (height, weight, hand size, arm circumference) and hand dominance [8–11], and is associated with different health outcomes [9,12], especially in elderly people [7]. It plays an important role in the evaluation of clinical and surgical treatment prognoses [13–15], functional evaluation of the elderly [16], identification of potential sports talents [17] and in the composition of the battery of admission tests in different professional activities such as police, armed forces and fire brigade [18]. Thus, the availability of reliable and up-to-date population reference values to which individuals can be compared is paramount [19]. There is a growing number of studies reporting HGS reference values [9,20,21], but their generalization is hampered by the variability of measurement instruments and protocols [22,23], differences between baseline populations, and use of non-representative samples [8,16]. Brazilian studies published on reference values for the population [8,24,25] are neither comparable nor generalizable to the entire Brazilian population, which presents diverse physical, cultural, social and economic variation from region to region. It is possible to observe very different HGS patterns from one region to another in the country. The establishment of HGS reference values for different populations makes it possible to detect differences between them but also serves to subsidizing efforts to construct more comprehensive or generalizable reference values. The understanding of the behavior of HGS in the population is important to create parameters in physical rehabilitation programs, as well as for the exploration of HGS levels discriminating the risk of occurrence of health conditions. This study aims to identify correlations between HGS and anthropometric variables and to establish HGS reference values for adult and elderly population g (...truncated)