title: 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.
authors.affiliation: From the Faculty of Health Sciences (M.J.M., J.N.B., P.F., M.S., J.B.), University of Sydney, New South Wales, Australia; Department of Sport, Health and Exercise Science (N.V.), University of Hull, UK; and Sydney Children's Hospitals Network (Randwick and Westmead) and Paediatric Gait Analysis Service of New South Wales (J.B.), Children's Hospital at Westmead, Sydney, Australia. marnee.mckay@sydney.edu.au.
authors.forename: Marnee J
authors.initials: MJ
authors.lastname: McKay
authors.affiliation: From the Faculty of Health Sciences (M.J.M., J.N.B., P.F., M.S., J.B.), University of Sydney, New South Wales, Australia; Department of Sport, Health and Exercise Science (N.V.), University of Hull, UK; and Sydney Children's Hospitals Network (Randwick and Westmead) and Paediatric Gait Analysis Service of New South Wales (J.B.), Children's Hospital at Westmead, Sydney, Australia.
authors.forename: Jennifer N
authors.initials: JN
authors.lastname: Baldwin
authors.affiliation: From the Faculty of Health Sciences (M.J.M., J.N.B., P.F., M.S., J.B.), University of Sydney, New South Wales, Australia; Department of Sport, Health and Exercise Science (N.V.), University of Hull, UK; and Sydney Children's Hospitals Network (Randwick and Westmead) and Paediatric Gait Analysis Service of New South Wales (J.B.), Children's Hospital at Westmead, Sydney, Australia.
authors.forename: Paulo
authors.initials: P
authors.lastname: Ferreira
authors.affiliation: From the Faculty of Health Sciences (M.J.M., J.N.B., P.F., M.S., J.B.), University of Sydney, New South Wales, Australia; Department of Sport, Health and Exercise Science (N.V.), University of Hull, UK; and Sydney Children's Hospitals Network (Randwick and Westmead) and Paediatric Gait Analysis Service of New South Wales (J.B.), Children's Hospital at Westmead, Sydney, Australia.
authors.forename: Milena
authors.initials: M
authors.lastname: Simic
authors.affiliation: From the Faculty of Health Sciences (M.J.M., J.N.B., P.F., M.S., J.B.), University of Sydney, New South Wales, Australia; Department of Sport, Health and Exercise Science (N.V.), University of Hull, UK; and Sydney Children's Hospitals Network (Randwick and Westmead) and Paediatric Gait Analysis Service of New South Wales (J.B.), Children's Hospital at Westmead, Sydney, Australia.
authors.forename: Natalie
authors.initials: N
authors.lastname: Vanicek
authors.affiliation: From the Faculty of Health Sciences (M.J.M., J.N.B., P.F., M.S., J.B.), University of Sydney, New South Wales, Australia; Department of Sport, Health and Exercise Science (N.V.), University of Hull, UK; and Sydney Children's Hospitals Network (Randwick and Westmead) and Paediatric Gait Analysis Service of New South Wales (J.B.), Children's Hospital at Westmead, Sydney, Australia.
authors.forename: Joshua
authors.initials: J
authors.lastname: Burns
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007537:Isometric Contraction / Q000502:physiology*; D008297:Male; D008875:Middle Aged; D053580:Muscle Strength / Q000502:physiology*; D053581:Muscle Strength Dynamometer; D018482:Muscle, Skeletal / Q000502:physiology*; D016059:Range of Motion, Articular / Q000502:physiology*; D012016:Reference Values; D055815:Young Adult