Growth Charts for Muscular Strength Capacity With Quantile Regression


      Muscle strength preservation may play an important role in protecting against cardiometabolic diseases, functional decline, musculoskeletal deterioration, and early all-cause mortality. However, sex-specific strength growth charts and curves using data from a U.S.-representative sample and clinically feasible measurement remain to be established.


      A sample of 7,119 individuals, aged 6–80 years, was included from the 2011–2012 National Health and Nutrition Examination Survey. Analyses were performed in 2015. Grip strength was assessed using a hydraulic handheld dynamometer; peak force values were normalized per body mass. Parametric quantile regression was used to determine unique normalized and absolute strength percentiles for men and women. Responses were fitted with a parametric model, involving six powers of age.


      Growth charts and curves were created using output from the quantile regression from reference values of normalized and absolute grip strength corresponding to the fifth, tenth, 25th, 50th, 75th, 90th, and 95th percentiles across all ages. For men, there was a small drop in normalized strength at age 6 years followed by quick growth until about age 25 years. Among women, normalized strength grew gradually until about age 15 years. For both men and women, normalized strength declined throughout middle age and later adulthood; however, these rates were greater among men. More-pronounced patterns of growth and decline were observed for absolute strength in men and women.


      The established strength quantiles can easily be incorporated into a clinical setting for screening individuals that would benefit from lifestyle interventions to improve muscular fitness and reduce health risks.
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        • Newman A.B.
        • Kupelian V.
        • Visser M.
        • et al.
        Strength, but not muscle mass, is associated with mortality in the health, aging and body composition study cohort.
        J Gerontol A Biol Sci Med Sci. 2006; 61: 72-77
        • Al Snih S.
        • Markides K.S.
        • Ray L.
        • Ostir G.V.
        • Goodwin J.S.
        Handgrip strength and mortality in older Mexican Americans.
        J Am Geriatr Soc. 2002; 50: 1250-1256
        • Ruiz J.R.
        • Sui X.
        • Lobelo F.
        • et al.
        Association between muscular strength and mortality in men: prospective cohort study.
        BMJ. 2008; 337: a439
        • Cooper R.
        • Strand B.H.
        • Hardy R.
        • Patel K.V.
        • Kuh D.
        Physical capability in mid-life and survival over 13 years of follow-up: British birth cohort study.
        BMJ. 2014; 348: g2219
        • Lopez-Jaramillo P.
        • Cohen D.D.
        • Gomez-Arbelaez D.
        • et al.
        Association of handgrip strength to cardiovascular mortality in pre-diabetic and diabetic patients: a subanalysis of the ORIGIN trial.
        Int J Cardiol. 2014; 174: 458-461
        • Cooper R.
        • Kuh D.
        • Hardy R.
        • et al.
        Objectively measured physical capability levels and mortality: systematic review and meta-analysis.
        BMJ. 2010; 341: c4467
        • McLean R.R.
        • Shardell M.D.
        • Alley D.E.
        • et al.
        Criteria for clinically relevant weakness and low lean mass and their longitudinal association with incident mobility impairment and mortality: the foundation for the National Institutes of Health (FNIH) sarcopenia project.
        J Gerontol A Biol Sci Med Sci. 2014; 69: 576-583
        • Alley D.E.
        • Shardell M.D.
        • Peters K.W.
        • et al.
        Grip strength cutpoints for the identification of clinically relevant weakness.
        J Gerontol A Biol Sci Med Sci. 2014; 69: 559-566
        • Ortega F.B.
        • Silventoinen K.
        • Tynelius P.
        • Rasmussen F.
        Muscular strength in male adolescents and premature death: cohort study of one million participants.
        BMJ. 2012; 345: e7279
        • Peterson M.D.
        • Saltarelli W.A.
        • Visich P.S.
        • Gordon P.M.
        Strength capacity and cardiometabolic risk clustering in adolescents.
        Pediatrics. 2014; 133: e896-e903
        • Cohen D.D.
        • Gomez-Arbelaez D.
        • Camacho P.A.
        • et al.
        Low muscle strength is associated with metabolic risk factors in Colombian children: the ACFIES study.
        PloS ONE. 2014; 9: e93150
        • Artero E.G.
        • Ruiz J.R.
        • Ortega F.B.
        • et al.
        Muscular and cardiorespiratory fitness are independently associated with metabolic risk in adolescents: the HELENA study.
        Pediatr Diabetes. 2011; 12: 704-712
        • Smith J.J.
        • Eather N.
        • Morgan P.J.
        • Plotnikoff R.C.
        • Faigenbaum A.D.
        • Lubans D.R.
        The health benefits of muscular fitness for children and adolescents: a systematic review and meta-analysis.
        Sports Med. 2014; 44: 1209-1223
        • Grontved A.
        • Ried-Larsen M.
        • Ekelund U.
        • Froberg K.
        • Brage S.
        • Andersen L.B.
        Independent and combined association of muscle strength and cardiorespiratory fitness in youth with insulin resistance and beta-cell function in young adulthood: the European Youth Heart Study.
        Diabetes Care. 2013; 36: 2575-2581
      1. Chen C. Growth charts of body mass index (BMI) with quantile regression. In: Arabnia H.R., Ajwa I.A., eds. Proceedings of the 2005 International Conference on Algorithmic Mathematics and Computer Science,AMCS 2005, Las Vegas, Nevada:114-120. Accessed May 26, 2015.

        • He X.M.
        • Hu F.F.
        Markov chain marginal bootstrap.
        J Am Stat Assoc. 2002; 97: 783-795
        • Spruit M.A.
        • Sillen M.J.
        • Groenen M.T.
        • Wouters E.F.
        • Franssen F.M.
        New normative values for handgrip strength: results from the UK Biobank.
        J Am Med Dir Assoc. 2013; 14: 775.e5-775.e11
        • Bohannon R.W.
        • Magasi S.
        Identification of dynapenia in older adults through the use of grip strength t-scores.
        Muscle Nerve. 2015; 51: 102-105
        • Dodds R.M.
        • Syddall H.E.
        • Cooper R.
        • et al.
        Grip strength across the life course: normative data from twelve British studies.
        PloS ONE. 2014; 9: e113637
        • Kenny R.A.
        • Coen R.F.
        • Frewen J.
        • Donoghue O.A.
        • Cronin H.
        • Savva G.M.
        Normative values of cognitive and physical function in older adults: findings from the Irish Longitudinal Study on Ageing.
        J Am Geriatr Soc. 2013; 61: S279-S290