Indian J Physiol Pharmacol 2001; 45 (3) : 355-360

IMPROVEMENT IN HAND GRIP STRENGTH IN NORMALVOLUNTEERS AND RHEUMATOID ARTHRITISPATIENTS FOLLOWING YOGA TRAINING

MANOJ DASH AND SHIRLEY TELLES*

Swami Vivekananda Yoga Research Foundation,No. # 9, 1st Main, Chamarajpet,Bangalore - 560 018

(Received on December 6, 2000)

Abstract : The present study aimed at assessing the effects of a set ofyoga practices on normal adults (n=37), children (n=86), and patients withrheumatoid arthritis (n=20). An equal number of normal adults, children,and patients with rheumatoid arthritis who did not practice yoga werestudied under each category, forming respective control groups. Yoga andcontrol group subjects were assessed at baseline and after varying intervals,as follows, adults after 30 days, children after 10 days and patients after15 days, based on the duration of the yoga program, which they attended,which was already fixed. Hand grip strength of both hands, measuredwith a grip dynamometer, increased in normal adults and children, and inrheumatoid arthritis patients, following yoga, but not in the correspondingcontrol groups, showing no re-test effect. Adult female volunteers andpatients showed a greater percentage improvement than correspondingadult males. This gender-based difference was not observed in children.Hence yoga practice improves hand grip strength in normal persons andin patients with rhematoid arthritis, though the magnitude of improvementvaries with factors such as gender and age.

Key words : hand grip powergender

yoga agerheumatoid arthritis

INTRODUCTION The practice of yoga for three monthswas found to increase hand grip strengthin male volunteers whose occupation was toteach physical education to high schoolstudents (9). This category of subjectsalready had 8 to 10 years of experience inphysical education and sports and may havebeen considered to be more likely to improvetheir muscle power, for that reason. Schoolchildren, of both sexes between 12 and 15

Hand grip strength has been used asan objective clinical measure in a varietyof situations. For example, grip strengthhas been used to assess general strengthin order to determine work capacity (1),for extent of injury and disease processesand the potential for and progress inrehabilitation (6) .

.*Corresponding Author

356 Dash and Telles

years of age, also showed improved handgrip strength following a yoga residentialcamp, which had yoga breathing, orpranayama (i .e ., voluntarily regulatedbreathing) as the main practice (8). Thisimprovement in hand grip strengthfollowing yoga, was also seen in patients inwhom the function of gripping is abnormaldue to disease. Patients with rheumatoidarthritis having pain and swelling of fingerjoints showed a trend of improvement inhand grip strength following a daily yogasession for 5 days a week, for 8 weeks,followed by weekly 2-hour sessions for afurther 3 months (2). Hence the earlierstudies, described above, investigated eitherselected subjects (e.g., adults with trainingin physical education), selected yogapractices (e.g., pranayama), or patients whowere given daily sessions of yoga practice,rather than training in lifestyle change.

The present study aimed at assessingthe effect of yoga training on grip strengthin: (i) adults who had no special earlier'physical training, (ii) children, following aten day yoga camp without specific emphasison anyone practice, and (iii) patients withrheumatoid arthritis who were given anintensive yoga therapy practice, includingsuggestions for life style and mental attitudechange.

METHODS

Subjects

There were 3 categories of subjects: (i)adults (n=37), (ii) children (n=86), and (iri)patients with rheumatoid arthritis (n=20),diagnosed based on standard clinicalcriteria. An equal number of adultvolunteers (n=37), children (n=86), and

Indian J Physiol Pharmacol 2001; 45(3)

patients with rheumatoid arthritis (n=20),who did not practice yoga formed therespective control groups. Details (e.g., agerange, number of subjects of each gender),are provided in Table I. Subjects were tested

. for hand dominance, by asking questionsabout which hand was used to comb the hair,throw a ball, or to write. Two left-handdominant subjects were excluded from thestudy.

Both groups (yoga, control) ofpatients were allowed to continuemedication which was prescribed for them.10 outof 20 patients of the yoga group and 6out of 20 patients of the control groupwere on NSAIDs (non-steroidal anti-inflammatory drugs) at the start of thestudy. The other patients were not receivingmedication. The drug score was notedas number of NSAID tablets per day.This was noted every day. However, foranalysis values on Day 1 and Day 14 wereused.

Design of the study

The three categories of subjects, viz.,adultes, children and patients withrheumatoid arthritis, received yoga forvarying periods based on the yoga camp theywere attending. For example, the durationof the yoga training camp was 1 month foradults (n=37), 10 days for children (n=86),and 14 days for rheumatoid arthritispatients (n=20). During these periods ofyoga practice, an equal number of "control"subjects of comparable age and sexwere studied at the beginning and end ofa period during which they did not practiceyoga, but carried on with their routineactivities. Hence "control" group subjectswere assessed as follows: adults (n=37), after

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1 month, children (n=86) after 10 days, andpatients (n=20) after 14 days.

Assessments

Hand grip strength of both hands wasassessed using a hand grip dynamometer(Anand Agencies, Pune, India). Subjectswere tested in 6 trials, 3 for each handalternately, with a gap of 10 secondsbetween trials. During the assessmentsubjects were asked to keep their armextended at shoulder level, horizontal to theground as has been described earlier (3).The maximum value obtained during thethree trials was used for statistical analysis.

Interventions

Certain yoga practices were taughtcommon to all three categories of subjects(i.e. adults, children, and patients). Theseincluded yoga asanas or postures (60minutes), pranayama or voluntarilyregulated breathing, meditation, andlectures about yoga philosophy. However, as

Improvement in Hand Grip Strength 357

part of the respective cour s es. otherpractices were specific for each of the threecategories of subject, i.e., additional yogapostures for adults, memory games forchildren which involved chanting versesfrom ancient Indian texts, and jointloosening exercises for patients withrheumatoid arthritis.

Analysis

The before and after comparison of eachcategory of subjects was analyzed forsubjects of each gender separately, using thepaired "t"-test (two-tailed).

RESULTS

Subjects of all three categories (i.e.,adult and child volunteers and adultpatients with rheumatoid arthritis) showedsignificant increases in hand grip strengthfollowing yoga. The control group, who didnot practice yoga showed no change. Thegroup mean values ± S.D. and percent

TABLE I: Details about subjects.

Number Age range Group meanSt. No Category Group Gender (n) (years) age±S.D.

(years)

1 Adults Yoga Male 21 22-50 31.0±7.4(n=74) Female 16 22-49 29.9±7.1

Control Male 21 22-50 32.3±6.7Female 16 20-40 26.4±6.4

2 Children Yoga Male 61 12-15 13.6±1.0(n=172) Female 25 12-15 13.5±0.9

Control Male 61 12-15 13.7±1.0Female 25 12-15 14.0±0.8

3 Patients Yoga Male 10 23-43 33.0±7.7(n=40) Female 10 26-43 35.0±5.3

Control Male 10 21-42 31.7±7.7Female 10 23-41 31.4±5.5

358 Dash and Telles Indian J Physiol Pharmacol 2001; 45(3)

TABLE II: Hand grip strength in adult volunteers, children, and adult patients of both groups (yoga andcontrol), before and after yoga or the non yoga control period, respectively. Values are groupmean ± SD.

Category Hand Before (kg) After (kg) %Change .Gender Group

Adults(n=74)

Mn=21 YOGA

LR

LR

LR

LR

LR

LR

LR

LR

43.1±4.7**45.5±5.2***

30.3±7.1***23.3±8.5***

12.411.6

27.324.3

-1.60.6

-3.8-0.5

Fn=16 YOGA

38.4±4.740.7±4.5

23.8±6.326.8±7.0

37.9±7.439.7±6.2

20.3±8.122.6±7.2

37.3±7.640.0±6.4

19.6±6.922.5±6.3

Mn=21 CONTROL

22.7±5.9***25.1±6.5***

20.9±3.3***23.2±4.0***

8.912.2

11.915.8

1.01.8

1.97.3

Fn=16 CONTROL

20.8±5.722.3±6.0

18.7±3.920.1±4.1

22.0±6.424.0±7.1

18.9±2.720.8±2.8

22.2±6.224.5±7.0

19.2±3.322.3±2.9

Children(n=172)

Mn=61 YOGA

LR

LR

LR

LR

33.2±5.3**33.0±5.8***

21.1±3.9***22.6±4.3***

39.522.2

148.2121.6

-1.61.1

5.3-2.6

Fn=25 YOGA

23.8±4.427.0±5.7

8.5±3.110.2±3.0

18.7±6.918.4±5.4

10.3±4.611.7±3.8

18.4±8.418.6±7.1

10.9±3.111.4±3.0

Mn=61 CONTROL

Fn=10 CONTROL

***p<. 001, **p<. 002, t-test for paired data, 'after' compared to 'before' for yoga and controlgroups separately

percent increase in grip strength was almostdouble that of girls after 10 days of yoga,and was also almost double that of adultmales, who also received 30 days of yogatraining. Percentage increase of boys andgirls were comparable. Patients, who wereall adults, showed greater percentageincrease following 15 days of yoga comparedto normal adults after 30 days of yoga.

Fn=25 CONTROL

Patients(n=40)

Mn=10 YOGA

Fn=10 YOGA

Mn=10 CONTROL

change where significant are given InTable II.

Among normal volunteers the percentageincreases following yoga were comparablefor male adults and children, for both handsafter 30 days (for adults) and 10 days (forchildren) of yoga, respectively. However, foradult females following 30 days of yoga, the

Indian J Physiol Pharmacal 2001; 45(3)

Among patients, female patients showed anincrease which was about thrice the increaseobserved in male patients.

The actual values (rather thanpercentage increase) showed that at baseline(i) adult male volunteers and patients hadhigher grip strength than correspondingfemale subjects (volunteers and patients,respectively). (ii) The gender difference inimprovement in grip strength following yogawas smaller between boys and girls. (Iii) Forall categories of subjects right hand gripstrength was greater than that of the lefthand.

Finally, the drug score data wereanalyzed. There was a significant reductionin Drug Score following 14 days of yoga, asvalues changed from 2.20 ± 1.4 (Day 1) to0.60 ± 0.5 (Day 14) [P=0.013]. The controlgroup showed no change. The values were:3.16 ± 1.6 (Day 1) and 1.83 ± 1.3 (Day 14)[P=0.22]. It should be noted however, thatat baseline the two groups differed in thefollowing points, viz., (1) 10 of the yogagroup were on NSAIDs, versus 6 of thecontrol group, with 20 patients in both cases(2). The drug scores of the 6 control grouppatients were higher than those of the 10yoga group patients at baseline, which mayalso account for differences in the resultsof the two groups.

DISCUSSION

The present study has shown thatfollowing yoga practice adult and childvolunteers and patients with rheumatoidarthritis show significant increases in hand

Improvement in Hand Grip Strength 359

grip strength. At baseline, as expected,adults show higher values than children,and males compared to females (4).The magnitude of increase in grip strengthfollowing yoga was maximum for femalepatients (about thrice the percentageincrease observed in male patients,even though the yoga program andthe duration were the same), followed byfemale volunteers whose percentageincrease was about double that of malevolunteers.

Yoga practice has already been shownto improve grip strength in adult malevolunteers trained in physical education (9),in children whose yoga program emphasizedpranayama (8), and in patients withrheumatoid arthritis who practiced yoga asa single session per day (2). Theimprovement in hand grip strength afteryoga practices, emphasizing pranayama, wasascribed to the oxygen requirement-reducingeffect of pranayama, as the availability ofenergy and oxidation of glucose is believedto influence the hand grip strengthproportionately (5). However, the increasein hand grip strength following other yogapractices, including pranayama couldbe due to different factors includingcognitive components and non-specificarousal (7).

Rheumatoid arthritis patients of thepresent study showed significantimprovement in hand grip strength, whereaspatients of an earlier study (2), showed anon-significant trend of improvement. Thisdifference could be related to the fact thatthe patients of the present study had an

360 Dash and Telles

intensive, though short duration program.These results may also suggest thatimprovement may be more rapid followinga short-term intensive yoga trainingprogram (i.e., in this case 15 days), asopposed to a longer duration (i.e., 8 weeksfollowed by 3 months), much less intensiveprogram, as described earlier (2). Thepresent study has also shown differences inthe percentage increase of improvement inhand grip strength after yoga, related tohand dominance, age, and gender. Righthand values were greater then left handvalues, and females showed greaterpercentage improvement then adult malesboth for normal volunteers and patients. The

Indian J Physiol Pharmacol 2001; 45(3)

exact reason for this difference is notknown.

Hence the present results haveshown that yoga practice increases handgrip strength, with different magnitudesof percent change depending on genderand age. However it should also benoted that the results, especiallythe magnitude of change in gripstrength following yoga, may havebeen related to the fact that the values atbaseline were lower than for the controlgroup, hence there was greater scope forimprovement in the yoga group, to beginwith.

REFERENCES

1. Gilbert J, Knowlton R. Simple method todetermine sincerity of effort during a maximalisometric test of grip strength. Am J Phy Med 1983;62: 135-144.

2. Haslock I, Monro R, Nagarathna R, Nagendra HR,Raghuram NV. Measuring the effects of yoga inrheumatoid arthritis. Br J Rheumatol 1994; 33(8):788.

3. Madan M, Thombre DP, Bharathi B, NambinarayanTK, Thakur S, Krishnamurthy N, ChandraboseA. Effects of yoga training on reactiontime, respiratory endurance and muscle strength.Indian J Physiol Pharmacol 1992; 36(4):229-233.

4. Mathiowetz V, Wiemer DM, Federman SM.Grip and pinch strength: norms for 6- to19- year olds. Am J Occ Ther 1986; 40(10):705-711.

5. Mohinder P, Malik SL. Effect of smoking onanthropometric somatotype and grip strengthIndian J Med Res 1988; 87: 494-499.

6. Petersen P, Petrick M, Connor H, Conklin D. Gripstrength and hand dominance: Challenging the 10%rule. Am J Occ Ther 1989; 43: 444-447.

7. Peynirciolu ZF, Thompson JL, Tanielian TB.Improvement strategies in free-throw shooting andgrip-strength tasks, J Gen Psychol 2000; 127(2):145-156.

8. Raghuraj P, Nagarathna R, Nagendra HR, TellesS. Pranayama increases grip strength withoutlateralized effects. Indian J Physiol Pharmacol1997; 41(2): 129-133.

9. Telles S, Nagarathna R, Nagendra HR, DesirajuT. Physiological changes in sports teachersfollowing 3 months of training in yoga. Indian JMed Sci 1993; 47(10): 235-238.