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Duran I, Wloka KR, Martakis K, Spiess K, Alexy U, Schoenau E. Multivariable reference centiles for maximum grip strength in childhood to young adults. Eur J Clin Nutr 2024; 78:494-500. [PMID: 38158405 PMCID: PMC11182743 DOI: 10.1038/s41430-023-01395-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 12/06/2023] [Accepted: 12/13/2023] [Indexed: 01/03/2024]
Abstract
OBJECTIVES Maximum grip strength (mGS) is a useful predictor of health-related outcomes in children and adults. The aim of the study was to generate sex- and age-adjusted reference centiles for mGS for children, adolescents and young adults, while adjusting for body height and body mass index (BMI). METHODS A retrospective analysis of longitudinal data from children and young adults participating in the DOrtmund Nutritional and Anthropometric Longitudinally Designed (DONALD) study (single center, open cohort study) from 2004 to 2022 was conducted. To generate sex-, age-, height- and BMI-adjusted reference centiles, a new algorithm combining multiple linear regression and the LMS method was conducted. RESULTS Overall, 3325 measurements of mGS of 465 females and 511 males were eligible. The mean age at measurement of females was 12.6 ± 3.9 years, mean age of males was 12.4 ± 4.7 years. The median of number of repeated measurements per individual was 3 (range 1-8). The mGS was significantly (p < 0.001) correlated to body height and BMI (r = 0.303-0.432). Additional reference centiles for the change of z-scores of mGS were generated for children and young adults from 8 to 20 years. CONCLUSIONS We proposed to evaluate mGS in children, adolescents and young adults with the presented reference centiles adjusted to sex, age, height and BMI. The method presented may also be applicable to other biological variables that depend more than just on sex and age. For the first time, also reference centiles to assess the change of mGS in repeated measurements were presented.
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Affiliation(s)
- Ibrahim Duran
- University of Cologne, Medical Faculty and University Hospital, Center of Prevention and Rehabilitation, UniReha, Cologne, Germany.
- University of Cologne, Medical Faculty and University Hospital, Department of Pediatrics, Cologne, Germany.
| | - Kim Ramona Wloka
- University of Cologne, Medical Faculty and University Hospital, Center of Prevention and Rehabilitation, UniReha, Cologne, Germany
| | - Kyriakos Martakis
- University of Cologne, Medical Faculty and University Hospital, Department of Pediatrics, Cologne, Germany
- Department of Pediatric Neurology, University Children's Hospital and Medical Faculty, Justus Liebig University of Giessen, Giessen, Germany
| | - Karoline Spiess
- University of Cologne, Medical Faculty and University Hospital, Center of Prevention and Rehabilitation, UniReha, Cologne, Germany
| | - Ute Alexy
- Institute of Nutritional and Food Sciences, Nutritional Epidemiology, DONALD Study, University of Bonn, Dortmund, Germany
| | - Eckhard Schoenau
- University of Cologne, Medical Faculty and University Hospital, Center of Prevention and Rehabilitation, UniReha, Cologne, Germany
- University of Cologne, Medical Faculty and University Hospital, Department of Pediatrics, Cologne, Germany
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Avitabile CM, Weber DR, Zemel BS. Paediatric dominant and non-dominant handgrip reference curves and the association with body composition. Ann Hum Biol 2024; 51:2298474. [PMID: 38293777 PMCID: PMC11164034 DOI: 10.1080/03014460.2023.2298474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Accepted: 12/06/2023] [Indexed: 02/01/2024]
Abstract
BACKGROUND Lack of paediatric reference data limits the utility of handgrip strength as a measure of fitness and well-being. AIM To develop paediatric handgrip reference curves and evaluate associations with body size and composition and race/ethnicity group. SUBJECTS AND METHODS Handgrip, body size and composition data were obtained from National Health and Nutrition Examination Survey 2011-2014 participants aged 6-20 years. Densitometry-derived fat and appendicular lean soft tissue mass index Z-scores (FMIZ, ALSTMIZ) were generated in participants >8 years. Dominant and non-dominant handgrip reference curves were created using the LMS method. Analyses included sample weights to produce nationally representative estimates. RESULTS Differences in handgrip strength according to hand dominance increased with age. Handgrip strength was associated with height and arm length Z-scores (R = 0.42 to 0.47) and ALSTMIZ (R = 0.54). Handgrip strength was higher in the non-Hispanic Black group and lower in the Mexican American compared to non-Hispanic White group. Group differences were attenuated when adjusted for height, arm length or ALSTMIZ. CONCLUSION Paediatric handgrip reference curves were generated from which individual Z-scores can be calculated separately for dominant versus non-dominant hand and adjusted for body size. Association with ALSTMIZ suggests handgrip Z-score may be used as a measure of functional body composition.
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Affiliation(s)
- Catherine M. Avitabile
- Deptartment of Paediatrics, University of PA Perelman School of Medicine, Philadelphia, PA, USA
- Division of Cardiology, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - David R. Weber
- Deptartment of Paediatrics, University of PA Perelman School of Medicine, Philadelphia, PA, USA
- Division of Endocrinology, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Babette S. Zemel
- Deptartment of Paediatrics, University of PA Perelman School of Medicine, Philadelphia, PA, USA
- Division of Gastroenterology, Hepatology, and Nutrition, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
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Gerber M, Filippou K, Knappe F, Morres ID, Tzormpatzakis E, Havas E, Seelig H, Colledge F, Ludyga S, Meier M, Theodorakis Y, von Känel R, Pühse U, Hatzigeorgiadis A. Associations between grip strength, cardiorespiratory fitness, cardiovascular risk and mental health in forcibly displaced people from a Greek refugee camp. Sci Rep 2023; 13:20970. [PMID: 38017094 PMCID: PMC10684690 DOI: 10.1038/s41598-023-48032-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 11/21/2023] [Indexed: 11/30/2023] Open
Abstract
Muscular strength represents a specific component of health-related fitness. Hand grip strength is used as a simple and dynamic marker of maximum voluntary force of the hand and to estimate overall strength. Today, little is known about the relationship between grip strength and health in forcibly displaced populations. In the present study, we examined whether grip strength is associated with various health outcomes in a sample of forcibly displaced people living in a Greek refugee camp. The present analyses are part of a larger pragmatic randomized controlled trial. In this paper, cross-sectional baseline data of 143 participants (71 men, 72 women) will be presented. In addition to grip strength, the following physical and mental health outcomes were assessed: body weight and body composition, blood pressure, total cholesterol, low- and high-density lipoprotein cholesterol, triglycerides, blood glucose levels (HbA1c), post-traumatic stress disorder (PTSD) symptoms, depressive and anxiety symptoms, pain, and quality of life. Linear regression analyses were carried out to examine how grip strength is associated with the health outcomes, separately for absolute and normalized grip strength scores. Grip strength was positively and strongly associated with percentage muscle mass (normalized grip strength: Stand. B = 0.58, p < .001), whereas a negative association existed for percentage body fat (normalized grip strength: Stand. B = - 0.58, p < .001). No statistically significant associations occurred between grip strength and the other cardiovascular risk markers. In contrast, we found that participants with higher normalized grip strength reported higher levels of PTSD (normalized grip strength: Stand. B = 0.36, p < .05) and depressive symptoms (normalized grip strength: Stand. B = 0.29, p < .05). No significant association occurred between grip strength, anxiety, pain and quality of life. Measuring grip strength in forcibly displaced people can be a useful way to assess their overall muscle strength. Grip strength tests are easy to implement, and results can be used to assess the effects of specific intervention measures. Nevertheless, our results question the usefulness of grip strength as a marker of cardiovascular health and mental wellbeing in a refugee camp setting.
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Affiliation(s)
- Markus Gerber
- Department of Sport, Exercise and Health, University of Basel, Grosse Allee 6, 4052, Basel, Switzerland.
| | - Konstantinia Filippou
- Department of Physical Education and Sport Sciences, University of Thessaly, Trikala, Greece
| | - Florian Knappe
- Department of Sport, Exercise and Health, University of Basel, Grosse Allee 6, 4052, Basel, Switzerland
| | - Ioannis D Morres
- Department of Nutrition and Dietetics, University of Thessaly, Trikala, Greece
| | - Emmanouil Tzormpatzakis
- Department of Physical Education and Sport Sciences, University of Thessaly, Trikala, Greece
| | - Elsa Havas
- Department of Physical Education and Sport Sciences, University of Thessaly, Trikala, Greece
| | - Harald Seelig
- Department of Sport, Exercise and Health, University of Basel, Grosse Allee 6, 4052, Basel, Switzerland
| | - Flora Colledge
- Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
| | - Sebastian Ludyga
- Department of Sport, Exercise and Health, University of Basel, Grosse Allee 6, 4052, Basel, Switzerland
| | - Marianne Meier
- Interdisciplinary Center for Gender Studies, University of Bern, Bern, Switzerland
| | - Yannis Theodorakis
- Department of Physical Education and Sport Sciences, University of Thessaly, Trikala, Greece
| | - Roland von Känel
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Uwe Pühse
- Department of Sport, Exercise and Health, University of Basel, Grosse Allee 6, 4052, Basel, Switzerland
| | - Antonis Hatzigeorgiadis
- Department of Physical Education and Sport Sciences, University of Thessaly, Trikala, Greece
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Torres-Costoso A, Zymbal V, Janz KF, Martínez Vizcaíno V, Baptista F. Body composition and musculoskeletal fitness: A cluster analysis for the identification of risk phenotypes for pediatric sarcopenia. Clin Nutr 2023; 42:1151-1158. [PMID: 37244754 DOI: 10.1016/j.clnu.2023.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 04/27/2023] [Accepted: 05/12/2023] [Indexed: 05/29/2023]
Abstract
BACKGROUND AND AIM Sarcopenia is primarily a disease in older people characterized by reduced muscle mass and strength. Nevertheless, sarcopenia may, at least partially, have pediatric origins. The study aimed to identify risk phenotypes for sarcopenia in healthy young people using clustering analysis procedures based on body composition and musculoskeletal fitness. METHODS We conducted a cluster cross-sectional analysis of data from 529 youth aged 10-18 yr. Body composition was assessed using whole-body dual-energy x-ray absorptiometry (DXA), determining: lean body mass index (LBMI, kg/m2), fat body mass index (FBMI, kg/m2), abdominal FBMI (kg/m2), and lean body mass/fat body mass ratio (LBM/FBM); body mass index was also calculated (BMI, kg/m2). Musculoskeletal fitness was assessed using handgrip strength (kg) and vertical jump power (W) tests. Results were presented as absolute values and adjusted by body mass. Plank endurance (s) was also assessed. All variables were sex and age in years standardized (Z-score). LBMI or LBM/FBM ratio ≤ -1 SD were used to identify participants at risk for sarcopenia. Maturity was estimated as the years of distance from the peak height velocity (PHV) age. RESULTS Using the Z-score means for body composition and musculoskeletal fitness and having LBMI or LBM/FBM ratio as the categorical variables (at risk vs. not at risk), the cluster analyses indicated three homogeneous groups (phenotypes, P): P1, risk body composition and unfit; P2, non-risk body composition and non-fit, and P3, non-risk body composition and fit. With the LBMI as a categorical variable, the ANOVA models showed that the body composition and absolute values of musculoskeletal fitness were in P1 < P2 < P3 and the estimated PHV age of P1 > P3 in both sexes (p < 0.001). Having the LBM/FBM as a categorical variable, higher values of BMI, FBMI, and abdominal FBMI, and lower values of handgrip strength and vertical jump power both adjusted for body mass and plank endurance were observed in P1 than in P2 and/or P3 and the P2 than in the P3 in boys and girls (p < 0.001). CONCLUSIONS Two risk phenotypes for sarcopenia were identified in apparently healthy young people: I. a low LBMI phenotype with low BMI and II. a low LBM to FBM phenotype with high BMI and FBMI. In both risk phenotypes I and II, musculoskeletal fitness was low. For screening, we suggest using absolute measures of handgrip strength and vertical jump power in phenotype I and body mass adjusted measures of these markers, as well as the plank endurance time in phenotype II.
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Affiliation(s)
- Ana Torres-Costoso
- Faculty of Physiotherapy and Nursing, Universidad de Castilla-La Mancha, Toledo, Spain; Health and Social Research Center, Universidad de Castilla La Mancha, Cuenca, Spain.
| | - Vera Zymbal
- CIPER, Faculdade de Motricidade Humana, Universidade de Lisboa, Lisbon, Portugal; ESS, Instituto Politécnico de Setúbal, Setúbal, Portugal
| | - Kathleen F Janz
- Department of Health and Human Physiology, Department of Epidemiology, The University of Iowa, Iowa City, USA
| | - Vicente Martínez Vizcaíno
- Health and Social Research Center, Universidad de Castilla La Mancha, Cuenca, Spain; Facultad de Ciencias de la Salud, Universidad Autónoma de Chile, Talca, Chile
| | - Fátima Baptista
- CIPER, Faculdade de Motricidade Humana, Universidade de Lisboa, Lisbon, Portugal
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Cade Abrams T, Terlizzi BM, De Meester A, Sacko RS, Megan Irwin J, Luz C, Rodrigues LP, Cordovil R, Lopes VP, Schneider K, Stodden DF. Potential Relevance of a Motor Skill “Proficiency Barrier” on Health-Related Fitness in Youth. Eur J Sport Sci 2022:1-8. [PMID: 36437559 DOI: 10.1080/17461391.2022.2153300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
This study investigated the potential impact of a motor skill proficiency barrier on measures of cardiorespiratory (CRF) and musculoskeletal (MSF) fitness in youth. A sample of 241 youth (114 girls) aged 10 - 18 years, completed the Motor Competence Assessment battery with composite scores indexed according to age- and gender-adjusted percentile scores. Motor competence (MC) levels were categorized as low (≤ 25%tile - proficiency barrier), moderate (≥ 26%tile to < 75%tile), and high (≥ 75%tile). CRF levels (Health Risk, Needs Improvement, and Healthy) were assessed using the Fitnessgram® 20 m PACER test. Low (≤ 20%tile), moderate (≥ 21%tile to ≤ 80%tile), and high (≥ 80%tile) MSF levels were assessed using grip strength normative data. Two 3 × 3 chi-square tests were conducted to determine the probability of MC level predicting CRF and MSF levels. Results demonstrated statistically significant models for performance on both the PACER (χ2[4, N = 241] = 22.65, p < .001) and grip strength (χ2[4, N = 241] = 23.95, p < .001). Strong evidence of a proficiency barrier impacting CRF was noted, as no low skilled youth met the "Healthy" fitness zone standards for PACER performance. Evidence supporting a barrier with grip strength was not as strong, as 20.8% of youth exhibiting low MC displayed high grip strength. However, all individuals with high levels of MC demonstrated at least moderate grip strength. Results emphasize the importance of developing MC during childhood as it may provide a protective effect against unhealthy CRF and MSF across youth.HighlightsThese data support the notion of Seefeldt's (1980) proficiency barrier as it relates to CRF, as no youth demonstrating low MC met the healthy fitness zone criteria for PACER performance. The development of MC may both directly and indirectly provide a protective effect against unhealthy CRF levels across childhood and adolescence.Evidence supporting a proficiency barrier with MSF as measured by grip strength was not as strong; however, all individuals with high levels of MC demonstrated at least moderate grip strength. Thus, the development of MC may be a protective factor to mitigate low levels of MSF via enhanced neuromuscular function.Promoting the development of MC in a variety of developmentally appropriate activities and settings (e.g. MC skills practice, structured and unstructured play, and performance contexts) is important to promote positive trajectories of CRF and MSF across childhood and adolescence.
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Affiliation(s)
- T. Cade Abrams
- Human Performance and Development Lab, Department of Physical Education, University of South Carolina, Columbia, South Carolina, USA
| | - Bryan M. Terlizzi
- Human Performance and Development Lab, Department of Physical Education, University of South Carolina, Columbia, South Carolina, USA
| | - An De Meester
- Human Performance and Development Lab, Department of Physical Education, University of South Carolina, Columbia, South Carolina, USA
| | - Ryan S. Sacko
- Department of Health and Human Performance, The Citadel, South Carolina, USA
| | - J. Megan Irwin
- Department of Health and Human Performance, The College of Charleston, South Carolina, USA
| | - Carlos Luz
- Escola Superior de Educação de Lisboa, Instituto Politécnico de Lisboa, 1549-003 Lisboa, Portugal
| | - Luís Paulo Rodrigues
- Escola Superior de Desporto e Lazer de Melgaço, Instituto Politécnico de Viana do Castelo, 4900-347, Viana do Castelo, Portugal
- Research Center in Sports Sciences Health Sciences and Human Development, (CIDESD), Portugal
| | - Rita Cordovil
- CIPER, Faculdade de Motricidade Humana, Universidade de Lisboa, Cruz Quebrada – Dafundo, Portugal
| | - Vítor P. Lopes
- Instituto Politécnico de Bragança, Campus de Santa Apolónia, 5300-223 Bragança, Portugal
- Research Center in Sports Sciences Health Sciences and Human Development, (CIDESD), Portugal
| | - Kirsten Schneider
- Human Performance and Development Lab, Department of Physical Education, University of South Carolina, Columbia, South Carolina, USA
| | - David F. Stodden
- Human Performance and Development Lab, Department of Physical Education, University of South Carolina, Columbia, South Carolina, USA
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Martínez-Torres J, Gallo-Villegas JA, Aguirre-Acevedo DC. Normative values for handgrip strength in Colombian children and adolescents from 6 to 17 years of age: estimation using quantile regression. J Pediatr (Rio J) 2022; 98:590-598. [PMID: 35487284 PMCID: PMC9617281 DOI: 10.1016/j.jped.2022.02.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 01/26/2022] [Accepted: 02/21/2022] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE The objective of this study is twofold: i) to estimate the normative values for handgrip strength and relative handgrip strength, specific to sex and age, for Colombian children and adolescents from 6 to 17 years of age using quantile regression models and ii) to compare the normative values for handgrip strength and relative handgrip strength in Colombian children and adolescents with those in children and adolescents in different countries. METHOD This was a cross-sectional analysis of a sample of 2647 youngsters. Handgrip strength was evaluated with a TKK 5101 digital dynamometer (Takei Scientific Instruments Co., Ltd., Tokyo, Japan). The relative handgrip strength was estimated according to weight in kilograms. The normative values were estimated to handgrip strength and relative handgrip strength through quantile regression models for the percentiles P5, P10, P25, P50, P75, P90, and P95 developed independently for each sex. All analyses were adjusted for the expansion factor. RESULTS The values for handgrip strength were considerably higher in males than in females in all age ranges. Additionally, as age increased for both sexes, the values for handgrip strength increased. The percentiles by sex and age for relative handgrip strength show for males a proportional increase according to age; for females, this did not occur. CONCLUSIONS When making comparisons with international studies, variability is observed in the methodologies used to evaluate handgrip strength and estimation methods, which could influence the discrepancies between the different reports.
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Affiliation(s)
| | - Jaime Alberto Gallo-Villegas
- Grupo GRINMADE, Facultad de Medicina, Universidad de Antioquia, Medellín, Colombia; Centro Clínico y de Investigación SICOR, Medellín, Colombia
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Zhang F, Bi C, Yin X, Chen Q, Liu Y, Li Y, Sun Y, Zhang T, Yang X, Li M. Roles of age, sex, and weight status in the muscular fitness of Chinese Tibetan children and adolescents living at altitudes over 3600 m: A cross-sectional study. Am J Hum Biol 2021; 34:e23624. [PMID: 34166556 DOI: 10.1002/ajhb.23624] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 05/18/2021] [Accepted: 05/19/2021] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVE This study aimed to assess the role of age, sex, and weight status in the development of muscular fitness in a large sample of Chinese Tibetan children and adolescents aged 7-18 years living in areas over 3600 m. METHOD A sample of 4673 Chinese Tibetan children and adolescents aged 7-18 years were recruited from 21 schools in three cities (Lhasa, Naqu, and Anduo) of Tibet, China. Grip strength, standing long jump, 30-s sit-ups, and 50-m dash were conducted to determine muscular fitness. Independent sample t tests were conducted to compare muscular fitness between boys and girls for each age group. The changes in mean scores on each muscular fitness test were estimated. The influence of weight status on muscular strength level was also estimated using one-way ANOVA and LSD tests. We also compared the average muscular fitness between Chinese Tibetan and Chinese average level. RESULTS The muscular fitness of Chinese Tibetan boys aged 7-18 years was higher than that of girls, with older children outperforming younger children. Among the Chinese Tibetan boys, those in the normal-weight group showed the best performance, whereas overweight group showed the best performance among the girls. The performance of Chinese Tibetan children and adolescents in standing long jump and 50-m dash was lower while that in sit-ups was higher than the performance of their Chinese counterparts. CONCLUSION Chinese Tibetan children and adolescents have relatively strong abdominal strength, but lower limb strength, which needs to be improved. Age, sex, and weight status should be considered when designing interventions to improve muscular fitness.
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Affiliation(s)
- Feng Zhang
- Key Laboratory of Adolescent Health Assessment and Exercise Intervention of Ministry of Education, East China Normal University, Shanghai, China.,College of Physical Education and Health, East China Normal University, Shanghai, China
| | - Cunjian Bi
- Key Laboratory of Adolescent Health Assessment and Exercise Intervention of Ministry of Education, East China Normal University, Shanghai, China.,College of Physical Education and Health, East China Normal University, Shanghai, China
| | - Xiaojian Yin
- Key Laboratory of Adolescent Health Assessment and Exercise Intervention of Ministry of Education, East China Normal University, Shanghai, China.,College of Physical Education and Health, East China Normal University, Shanghai, China.,College of Economics and Management, Shanghai Institute of Technology, Shanghai, China
| | - Qi Chen
- Key Laboratory of Adolescent Health Assessment and Exercise Intervention of Ministry of Education, East China Normal University, Shanghai, China.,College of Physical Education and Health, East China Normal University, Shanghai, China
| | - Yuan Liu
- Key Laboratory of Adolescent Health Assessment and Exercise Intervention of Ministry of Education, East China Normal University, Shanghai, China.,College of Physical Education and Health, East China Normal University, Shanghai, China
| | - Yuqiang Li
- Key Laboratory of Adolescent Health Assessment and Exercise Intervention of Ministry of Education, East China Normal University, Shanghai, China.,College of Physical Education and Health, East China Normal University, Shanghai, China
| | - Yi Sun
- Key Laboratory of Adolescent Health Assessment and Exercise Intervention of Ministry of Education, East China Normal University, Shanghai, China.,College of Physical Education and Health, East China Normal University, Shanghai, China
| | - Ting Zhang
- Key Laboratory of Adolescent Health Assessment and Exercise Intervention of Ministry of Education, East China Normal University, Shanghai, China.,College of Physical Education and Health, East China Normal University, Shanghai, China
| | - Xiaofang Yang
- Key Laboratory of Adolescent Health Assessment and Exercise Intervention of Ministry of Education, East China Normal University, Shanghai, China.,College of Physical Education and Health, East China Normal University, Shanghai, China
| | - Ming Li
- Key Laboratory of Adolescent Health Assessment and Exercise Intervention of Ministry of Education, East China Normal University, Shanghai, China.,College of Physical Education and Health, East China Normal University, Shanghai, China
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