Comparative study of body mass index, hand grip strength, and handgrip endurance in healthy individuals.
Physical fitness is the major mantra today and may it be yoga, aerobics, gym, etc.; many people around the world are conscious about their fitness. At the same time, many are suffering from diseases such as diabetes, hypertension and coronary artery disease, which are mainly due to sedentary lifestyle and unhealthy eating habits. The main aim of all the physical activities, diet, and lifestyle measures are to maintain normal range of body mass index (BMI). BMI is calculated as weight in kilograms divided by height in meters squared (kg/[m.sup.2]. BMI is easy to obtain as a measure of relative weight. It is an acceptable measure for thinness and fatness and has been directly related to health risks and death rates in many populations.  Handgrip strength (HGS) and handgrip endurance (HGE) are the important parameters to assess the upper extremity muscular strength of an individual. Evidence has shown that there were strong correlations between grip strength and various anthropometric parameters, such as weight, height, hand length, and BMI reported by some earlier studies. [3-5] HGS is a physiological variable which is affected by a number of factors such as age, gender, and body size among others. [6,7] Measurement of HGS is cheap and simple, and it is often used to evaluate muscle strength. As some of the studies show a negative correlation between BMI and HGS, some show a positive correlation between BMI and HGE. Furthermore, only a very few studies are done in this direction; hence, we took a study to compare and correlate BMI with HGS and endurance time (ET).
Aims and objectives of the study are to calculate the BMI of the subjects, to record HGS and ET in them, and to compare BMI with HGS and ET.
MATERIALS AND METHODS
Two hundred and one participants were included in our study, comprising both males and females of age group 20-45 years. We considered this age group because this age group is physically active group. Before 20 years, physical development will be taking place, and from 45 years onward, the mortality rate begins to increase. This study is a cross-sectional study done in the Department of Physiology, Hassan Institute of Medical Sciences, Hassan, after obtaining the Ethical Clearance (Dated 08-06-2015, IEC No: 32), and informed consent was obtained from the participants. The duration of our study was 4 months. The following are the inclusion and exclusion criteria. Healthy males and females of age group of 20-45 years were included in our study. Those suffering from hypertension, diabetes, any neuromuscular disorders, paralysis or hemipariesis, history of smoking or alcoholism, and history of intake of any drugs were excluded from the study. Body height was measured standing against a wall without shoes using a measuring tape in meters. Body weight was obtained with light indoor clothing in kilograms. BMI was calculated using Quetelet index. According to the WHO classification of BMI, participants were then categorized into three groups as normal weight BMI 18.5-24.9 kg/[m.sup.2], overweight BMI 24.9-29.9 kg/[m.sup.2], and obese >30 kg/[m.sup.2].
Measurement ofHGS was done using a handgrip dynamometer (Jagson India make). HGS was measured in participants in seated position with elbow by their side and flexed to right angles and a neutral wrist position and provision of support underneath the dynamometer. In this position, the participant is asked to compress the HGS dynamometer with maximum strength. HGS can be quantified by measuring the amount of static force that the hand can compress/squeeze around a dynamometer. The mean of three trials of grip strength is taken. This is referred to as maximum isometric tension, [T.sub.max] in kg and ET is measured by the time of onset of fatigue for 70% of the in [T.sub.max] [8-12] expressed in seconds.
A t-test was used for comparisons between BMI, HGS, and HGE. Pearson's correlation coefficients were used to establish the correlations of BMI with HGS and HGE. P < 0.05 is taken as a significant value.
Our study group consisted of 201 participants, of which 100 were male and 101 were female. Table 1 and Figure 1 show age-wise distribution of participants: 29% were of the age group 20-24 years, 43% were of the age group 25-29 years, 58% were of the age group 30-34 years, 35% were of the age group 35-39 years, and 36% were of the age group 40-44 years. Table 1 shows statistical analysis of height, weight, and BMI of all the participants expressed as mean and standard deviation. The average height was 1.62 [+ or -] 9.16 m, the average weight was 63.14 [+ or -] 9.94 kg, and average BMI was 23.8 [+ or -] 2.73 kg/[m.sup.2].
Tables 2-4 show correlation between overall BMI of the participants with HGS and HGE, and our result shows that there was a significant correlation between HGE and BMI, with P = 0.001 being highly significant, but there was no significant correlation between BMI and HGS.
Table 5 depicts the HGS and HGE in male and female participants. The HGS in male was 34.64 [+ or -] 7.52 kg and in female was 24.18 [+ or -] 5.67 kg. There was a highly significant difference in HGS between male and female groups, P < 0.0001. The HGE in male and female was 79.77 [+ or -] 39.56 s and 54.35 [+ or -] 22.98 s, respectively. The HGE was also highly significant in male as compared to female, P < 0.0001.
Table 6 depicts the various r and P-value in male and female participants, whose BMI was further classified into normal, overweight, and obese. Our results show that normal BMI males had a significant negative correlation between BMI and HGS (P < 0.046). Obese males had negative correlation between BMI and HGS, but it was not significant. Overweight females also had negative correlation between BMI and HGS, but it was not significant.
The results in our study show HGS was highly significant in males compared to females (P < 0.0001). Similar findings were noted by Das and Dutta,  Shetty et al.,  Manjuanth et al.,  Rolland et al.,  Ravisankar et al.,  and Leyk et al.  Muscle strength is determined largely by muscle girth; a muscle with a larger cross-sectional area can generate more force and therefore lift more weight than one with a smaller cross-sectional area. As the male hormone testosterone enlarges muscles, men tend to be stronger than women.  The greater muscle strength in males has been to a large extent attributed to differences in muscle mass. 
In addition, it was found that testosterone increases type II fibers,  which are the fast fibers with high glycolytic enzyme activity. The type II fibers are in high proportion in males. Increase strength in males is also attributed to increased bone mineral density in males,  thus males having higher HGS than females in our study.
When BMI was classified into normal, overweight, and obese, we found that male participants with normal BMI had a significant negative correlation with HGS (r = -0.257, P = 0.046). Massy-Westropp et al. in their study noted a very weak positive relationship between higher BMI and right HGS in the youngest and oldest age groups in the sample. They also noted that BMI was negatively correlated with HGS in age groups of 4th, 5th, and 6th decades.  Our study group consisted of age group between 20 and 45 years, which comes between youngest and oldest group, and hence, as noted in the previous study, in our study also, we noted a significant negative correlation between BMI and HGS. Disparity exists in previous studies over the relationship between HGS and BMI, many studies claiming a positive relationship between grip strength and BMI in both males and females and all age groups, while others found no relationship. [21-24] These studies involved participants of different age groups, genders, ethnicity, types of work, and food habits.
Figure 1: Age wise distribution of participants Age groups (years) 20-24 29 25-29 43 30-34 58 35-39 35 40-44 Note: Table made from bar graph.
A negative correlation was noted between BMI and HGS though not significant in some study. [2,5] There was no correlation between BMI with HGS and ET in overweight. Normal BMI males showed non-significant positive correlation between BMI and HGE and a non-significant negative correlation between BMI and HGE in overweight and obese males.
In obese males, both HGS and ET were negatively correlated but not significant. In obesity, it is mainly due to impairment of muscle strength by accumulation of fat; also, obese participants have fewer type I and more type IIb muscle fibers than their lean counterparts. Fat mass is inversely correlated with type I fibers and is positively correlated with type II fibers. [25-28] The muscle function is not significantly different between lean and obese participants when adjusted for their age, height, physical activity, pain, depression, and appendicular skeletal muscle mass.  Obese women have lower muscle strength of both upper and lower extremities when compared to lean women, which is explained by their lower degree of activity.  In overweight females, there was insignificant negative correlation observed between BMI with HGS. The study conducted by Podstawski et al.  revealed that overweight female students had a significantly lower level of endurance strength abilities than their underweight or normal peers. Das and Dutta,  in their study, found that males had higher HGS and endurance than females and a significant correlation between BMI and HGS and endurance in overweight and underweight participants. Shetty et al.  found that significant negative correlation between HGS and BMI in overweight males and significant positive correlation between HGE and BMI only in underweight males. There was positive correlation between BMI and ET in all the 200 subjects irrespective of sex and BMI (r = 0.241 and P < 0.001), which was highly significant. In our study, males showed a statistically insignificant positive correlation between the BMI and the HGE in normal weight group and statistically insignificant negative correlation between the BMI and the HGE in overweight and obese participants. Podstawski et al.  in their study noted that those in the higher BMI range are expected to perform worse in relative endurance-strength trials, such as 3-min Burpee test. Hulens et al.  reported that there was a statistically nonsignificant, positive correlation between the BMI and the HGE in underweight and normal weight males and a negative correlation in overweight males. In females, the correlation was insignificantly positive in the overweight group only.
In our study, we found that BMI and HGS are negatively correlated among normal BMI male participants and weakly negatively correlated among obese males. In overweight females, the HGS and BMI were also weakly negatively correlated and had no correlation in normal and obese female participants. HGE was weakly negatively correlated among overweight and obese males. HGS and HGE depend upon various factors such as age, sex, built, strength of muscle, arm span, and diet. A further study in a larger population is required with multiple factors taken into consideration such as waist circumference, waist to hip ratio, abdominal fat, and skin fold thickness, in addition to BMI for better conclusions.
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How to cite this article: Dhananjaya JR, Veena HC, Mamatha BS, Sudarshan CR. Comparative study of body mass index, hand grip strength, and handgrip endurance in healthy individuals. Natl J Physiol Pharm Pharmacol 2017;7(6):594-598.
Source of Support: Nil, Conflict of Interest: None declared.
Dhananjaya J R (1), Veena H C (2), Mamatha B S (1), Sudarshan C R (1)
(1)Department of Physiology, Hassan Institute of Medical Sciences, Hassan, Karnataka, India, (2)Department of Physiology, Kodagu Institute of Medical Sciences, Madikeri, Karnataka, India
Correspondence to: Dhananjaya J R, E-mail: email@example.com
Received: October 21, 2016; Accepted: February 07, 2017
Table 1: Physical data of the participants Parameters Number Total Males 100 201 Females 101 Parameters Number Mean[+ or -]SD Height 201 1.62[+ or -]9.16 Weight 201 63.14[+ or -]9.94 BMI 201 23.8[+ or -]2.73 BMI: Body mass index; SD: Standard deviation Table 2: Pearson's correlation coefficient between BMI with HGS and HGE Parameters Correlation coefficient value (r) P HGS 0.1 P=0.16 (*) HGE 0.24 P=0.001 (*) HGS: Handgrip strength, HGE: Handgrip endurance, BMI: Body mass index, P<0.05 Table 3: Correlation between BMI and HGS Parameters Mean[+ or -]SD n BMI 23.82[+ or -]2.73 201 HGS 29.38[+ or -]8.46 201 Correlations BMI HGS BMI Pearson correlation 1 0.100 Significant (two-tailed) 0.157 n 201 201 HGS Pearson correlation 0.100 1 Significant (two-tailed) 0.157 n 201 201 There is no correlation between BMI and HGS (P=0.157), HGS: Handgrip strength, HGE: Handgrip endurance, BMI: Body mass index, SD: Standard deviation Table 4: Correlation between BMI and ET Parameters Mean[+ or -]SD n BMI (kg/[m.sup.2]) 23.82[+ or -]2.73 201 HGE (s) 93[+ or -]63 201 Correlations BMI HGE BMI Pearson correlation 1 0.241 (**) Significant (two-tailed) 0.001 n 201 201 HGE Pearson correlation 0.241 (**) 1 Significant (two-tailed) 0.001 n 201 201 (**)Correlation is significant at the 0.01 level (two-tailed), There was positive correlation between BMI and ET (P=0.001), HGS: Handgrip strength, HGE: Handgrip endurance, BMI: Body mass index, ET: Endurance time, SD: Standard deviation Table 5: Comparison of HGS and HGE in males and females Parameters n Mean[+ or -]SD HGE-male 100 79.77[+ or -]39.57 HGE-female 101 54.35[+ or -]22.98 HGS-male 100 34.64[+ or -]7.52 HGS-female 101 24.18[+ or -]5.67 Valid n 100 (listwise) Males (mean[+ or -]SD) Females (mean[+ or -]SD) P HGS (kg) 34.64[+ or -]7.52 24.18[+ or -]5.67 <0.0001 HGE (s) 79.77[+ or -]39.56 54.35[+ or -]22.98 <0.0001 Both HGS and HGE in males were highly significant compared to females (P<0.0001), HGS: Handgrip strength, HGE: Handgrip endurance, SD: Standard deviation Table 6: Comparison between BMI and HGS and HGE in males and females expressed as Pearson's correlation coefficient BMI HGS HGE r P r P Male Normal -0.257 0.046 (*) 0.017 0.896 Overweight 0.048 0.782 -0.06 0.730 Obese -0.563 0.437 -0.274 0.726 Female Normal 0.09 0.422 -0.015 0.895 Overweight -0.112 0.659 0.241 0.335 Obese 0.00 1.0 0.00 1.0 (*)There was a significant negative correlation between normal BMI and HGS in males, HGS: Handgrip strength, HGE: Handgrip endurance, BMI: Body mass index
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|Title Annotation:||RESEARCH ARTICLE|
|Author:||J.R., Dhananjaya; H.C., Veena; B.S., Mamatha; C.R., Sudarshan|
|Publication:||National Journal of Physiology, Pharmacy and Pharmacology|
|Date:||Jun 1, 2017|
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