Norms for Core Strength in Children

I frequently get asked where you can find norms to measure core strength in children.  As pediatric therapists, we sometimes use supine flexion, prone extension, modified sit ups and push ups as measures of core strength.  I don’t usually refer to the norms but more look at the quality of how the exercise is performed and  progress over time for each individual child.  I do realize though that parents, teachers and administrators do like to understand norms to compare what a child should accomplish.  The norms used for supine flexion and prone extension are older but seem to be the most referenced articles.  If anyone knows of more updated, larger studies I would love to hear about them.

Supine Flexion – for each age group there were 40 participants.  Lying in supine, children were instructed to hold the following position: cross arms, flex knees to 90 degrees and “roll into a ball” by flexing neck, upper trunk and hips.   The results were recorded comparing boys to girls with the standard deviations ranging from 6.7 to 39.7.

SUPINE FLEXION (LEFKOF RESULTS)

AGE IN YEARS                                    BOYS (SECONDS)                             GIRLS (SECONDS)

3                                                              15.5                                                        15.8

4                                                              17                                                           20.1

5                                                              27.4                                                        29.5

6                                                              55.4                                                        52

Reference:  Marsha B Lefkof. Trunk Flexion in Healthy Children Aged 3 to 7 Years. PHYS THER January 1986 66:39-44

Prone Extension – There were 26 four year olds, 28 six year olds and 30 eight year olds in the study.  They were instructed to lay on their stomach and lift up head, chest, arms and legs off the floor with knees straight and elbows bent.  The standard deviation ranged from 5.67-13.45.

PRONE EXTENSION (HARRIS RESULTS)
AGE IN YEARS                                    POSITION HELD (SECONDS)

4                                                              18.15

6                                                              28.93

8                                                              Every participant held position for 30 seconds

Reference: Harris, N. Duration and Quality of the Prone Extension Position in Four, Six and Eight Year Old Normal Children.  AJOT. January 1981Vol 35 No 1.

PRONE EXTENSION 6-9 YEAR OLDS (BOWMAN & KATZ RESULTS) – 153 right hand dominant participants

AGE IN YEARS                                    POSITION HELD (SECONDS)

6                                                              76.32

7                                                              77.72

8                                                              110.82

9                                                              115.14

Reference: Bowman, JO and Katz, B. Hand Strength and Prone Extension in RIght Dominant 6-9 Year Olds. Am J Occup Ther. 1984; 38(6):367-376. doi: 10.5014/ajot.38.6.367.

PRESIDENTIAL YOUTH FITNESS PROGRAM – The program uses FITNESSGRAM®, which provides an efficient way for physical educators to perform evidence-based health-related fitness assessments.  Here is more info about the program and directions – http://www.pyfp.org/doc/fitnessgram/fg-07-muscular.pdf

BOYS AND GIRLS

AGE       CURL UP(# COMPLETED)              TRUNK LIFT (INCHES)     PUSH UP (#COMPLETED)

5 and 6                  ≥2                                                           6-12                                       ≥3

7                              ≥4                                                           6-12                                       ≥4

8                              ≥6                                                           6-12                                       ≥5

9                              ≥9                                                           6-12                                       ≥6

10                           ≥12                                                         9-12                                       ≥7

These result go all the way to 17 years plus which you can view here – http://www.pyfp.org/doc/fitnessgram/fg-09-interpreting.pdf

Reference:   The Cooper Institute (2010).FITNESSGRAM® for the Presidential Youth Fitness Program.

Title: Play Strong: Activities to Promote Muscle Strengthening in 
Children Through Play  

By: Your Therapy Source  

Summary: Download of electronic book with activities to promote muscle 
strengthening in children.  FIND OUT MORE INFORMATION

Postural Painting

Here is a fun twist on painting that will also encourage strengthening of the core muscles.  Hang up some paper on the wall.  We hung it up on some cardboard in case the kids paint off the paper.

Put some paint on a tray.  The child can lay of the floor on his/her back.

To get those abdominal muscles working, the child then puts both feet in the paint, lifts up and presses feet against the paper.  Make sure the child keep the small of the back flat on the floor as they lift the feet.

For some extensor strengthening (back muscles) put the child over a ball or bolster.  The child puts his/her hands in the tray, lifts up and presses hand against the paper.

To increase the difficulty, see if the child can hold his/her upper body off the ball and glide his/her hands all over the paint.

Have a bucket of water or wipes close by to clean up the feet and hands when all done.

Title: Play Strong: Activities to Promote Muscle Strengthening in 
Children Through Play

By: Your Therapy Source

Summary: Download of electronic book with activities to promote muscle
strengthening in children.  Find out more at http://yourtherapysource.com/playstrong.html

Core Stability Training Versus Task Oriented Training

Clinical Rehabilitation published research comparing core stability training versus task oriented training in improving motor proficiency in 22 children with developmental coordination disorder (DCD), ages 6-9 years old.  The intervention consisted of one time per week for 8 weeks, face to face sessions of either core stability exercises or task oriented training.  Children in both groups also were asked to carry out home exercise programs daily.  

For assessment, the Short Form of the Bruininks-Oseretsky Test of Motor Proficiency (Second Edition) and Sensory Organization Test were utilized pre- and post-intervention with the following results recorded:

1.  Intention-to-treat analysis revealed no significant between-group difference in the change of motor proficiency standard score and composite equilibrium score on the Sensory Organization Test 

2.  change after the intervention indicated significant improvement in motor proficiency in both the core stability and task-oriented training groups.

3.  the composite equilibrium score was significantly increased in the task-oriented training group, but not in the core stability group.

4.  with the task-oriented training group, compliance with the home program was positively correlated with change in motor proficiency and composite equilibrium score.

The researchers concluded that the core stability exercise program was as effective as task-oriented training in improving motor proficiency among children with DCD.

Reference:  Mei K Au et al.  Core stability exercise is as effective as task-oriented motor training in improving motor proficiency in children with developmental coordination disorder: a randomized controlled pilot study. Published online before print March 25, 2014, doi: 10.1177/0269215514527596 Clin Rehabil March 25, 2014 0269215514527596.

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Play Strong: Activities to Promote Muscle Strengthening in Children Through Play      By: Your Therapy Source Inc

Summary: Download of electronic book with activities to promote muscle strengthening in children.  Find out more information at http://yourtherapysource.com/playstrong.html