ORIGINAL RESEARCH

published: 13 May 2021

doi: 10.3389/fphys.2021.668055

Estimation of Health-Related
Physical Fitness Using Multiple
Linear Regression in Korean Adults:
National Fitness Award 2015–2019
Sung-Woo Kim 1† , Hun-Young Park 1,2† , Hoeryong Jung 3 , Jinkue Lee 3 and Kiwon Lim 1,2,4*
1
Physical Activity and Performance Institute, Konkuk University, Seoul City, South Korea, 2 Department of Sports Medicine
and Science, Graduate School, Konkuk University, Seoul City, South Korea, 3 Department of Mechanical Engineering,
Konkuk University, Seoul City, South Korea, 4 Department of Physical Education, Konkuk University, Seoul City, South Korea

Continuous health care and the measurement of health-related physical fitness (HRPF)
is necessary for prevention against chronic diseases; however, HRPF measurements
including laboratory methods may not be practical for large populations owing to
constraints such as time, cost, and the requirement for qualified technicians. This study
Edited by: aimed to develop a multiple linear regression model to estimate the HRPF of Korean
Carlo Zancanaro,
adults, using easy-to-measure dependent variables, such as gender, age, body mass
University of Verona, Italy
index, and percent body fat. The National Fitness Award datasets of South Korea
Reviewed by:
Rute Santos, were used in this analysis. The participants were aged 19–64 years, including 319,643
Laboratory for Applied Health male and 147,600 females. HRPF included hand grip strength (HGS), flexibility (sit and
Research (LabinSaúde), Portugal
Hamid Arazi, reach), muscular endurance (sit-ups), and cardiorespiratory fitness (estimated VO2max ).
University of Guilan, Iran An estimation multiple linear regression model was developed using the stepwise
*Correspondence: technique. The outlier data in the multiple regression model was identified and removed
Kiwon Lim
when the absolute value of the studentized residual was ≥2. In the regression model,
[email protected]
† These authors have contributed
the coefficient of determination for HGS (adjusted R2 : 0.870, P < 0.001), muscular
equally to this work and share first endurance (adjusted R2 : 0.751, P < 0.001), and cardiorespiratory fitness (adjusted R2 :
authorship 0.885, P < 0.001) were significantly high. However, the coefficient of determination
Specialty section:
for flexibility was low (adjusted R2 : 0.298, P < 0.001). Our findings suggest that
This article was submitted to easy-to-measure dependent variables can predict HGS, muscular endurance, and
Exercise Physiology,
cardiorespiratory fitness in adults. The prediction equation will allow coaches, athletes,
a section of the journal
Frontiers in Physiology healthcare professionals, researchers, and the general public to better estimate the
Received: 15 February 2021 expected HRPF.
Accepted: 16 April 2021
Keywords: health-related physical fitness, multiple linear regression, cardiorespiratory fitness, hand grip
Published: 13 May 2021
strength, muscular endurance
Citation:
Kim S-W, Park H-Y, Jung H, Lee J
and Lim K (2021) Estimation
of Health-Related Physical Fitness
INTRODUCTION
Using Multiple Linear Regression
in Korean Adults: National Fitness
Physical fitness is defined as a physiological state of wellbeing in which one can perform daily
Award 2015–2019. activities without strain, or that provides the basis for exercise performance. Health-related physical
Front. Physiol. 12:668055. fitness (HRPF) includes components related to a health condition, such as musculoskeletal and
doi: 10.3389/fphys.2021.668055 cardiorespiratory fitness (CRF; Liguori and American College of Sports Medicine, 2020).

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Kim et al. Estimation of Health-Related Physical Fitness

Health-related physical fitness and physical activity (PA) advances in health care and sports science have provided coaches,
level are often used together, with physical fitness generally athletes, healthcare professionals, and researchers with efficient,
considered a more accurate measurement of PA level than reliable, and economical means to record health-related and
self-reported assessments (Williams, 2001). PA involves body exercise performance data (Seshadri et al., 2017; Aroganam et al.,
movements caused by skeletal muscle contractions that increase 2019; Kim et al., 2019a; Ray et al., 2019). The connected gains
energy consumption beyond the basic level (Meredith and Welk, of novel analytical techniques, portable and reliable devices,
2010; Liguori and American College of Sports Medicine, 2020). and comprehensive software programs suggest that research on
Systematic research on the association between PA and health health promotion will increase in the future (Loncar-Turukalo
conditions began six decades ago, and since then, the scientific et al., 2019). Several predictive equations have been developed to
literature has confirmed the relationship between these two estimate HRPF to increase utility for field-based research (Esco
areas (Liguori and American College of Sports Medicine, 2020). et al., 2008; Shenoy et al., 2012; Lopes et al., 2018; Zaccagni et al.,
Physical fitness was reported to be similar to PA in terms of its 2020). These previous studies generally linked HRPF parameters
association with morbidity and mortality (Blair and Brodney, to laboratory evaluations. However, there were differences in the
1999; Erikssen, 2001). However, physical fitness predicts health equation’s estimation reliability due to sample size, the number of
outcomes more strongly than PA (Blair et al., 2001; Williams, independent variables, differences in measurement methods, and
2001; Myers et al., 2004). Previous studies have shown at least a statistical analysis methods.
50% decrease in mortality among individuals with a high physical Therefore, our study aimed to develop a multiple linear
fitness level compared to those with a low physical fitness level regression model to predict HRPF parameters (e.g., HGS,
(Myers et al., 2004). In addition to serving as a prognostic and flexibility, muscular endurance, and CRF) using easy-to-measure
diagnostic health indicator in clinical settings, CRF has been used dependent variables [e.g., gender, age, body mass index (BMI),
as an indicator of regular exercise (Lin et al., 2015). Warburton and percent body fat] in Korean adults.
et al. reported that the physiological functions of the human
body and HRPF continuously decrease with aging, leading to
an increased risk for chronic diseases (Warburton et al., 2006). MATERIALS AND METHODS
Among the HRPF components, the CRF index’s maximal oxygen
uptake decreases by about 3–6% due to aging (Fleg et al., 2005). Datasets
High levels of HRPF maintained from adulthood can reduce The National Fitness Award (NFA) datasets of South Korea were
musculoskeletal, cardiovascular, and metabolic diseases such as used in this analysis. The NFA is a nationwide test in 75 sites
osteoporosis, sarcopenia, hypertension, and diabetes (Carnethon that assesses the physical fitness of the general population in
et al., 2003; Katzmarzyk et al., 2004; Barry et al., 2014; Kim South Korea. This study included male and female (age: 19–64
et al., 2019b). The HRPF is an indirect health indicator of the years) who participated in the NFA from 2015 to 2019. Among
body, and continuous care is important. Therefore, all of the a total of 457,942 adults, we excluded participants who had no
previous study findings establish the need to include HRPF data on their dependent variables (n = 640) and had no data
testing in health condition monitoring systems (Ortega et al., on their HRPF parameters (n = 669). Finally, a total of 456,633
2008). Furthermore, the World Health Organization suggested adults (male: n = 210,613, female: n = 246,020) were included
that regular physical fitness and PA testing should be examined in the analysis. Male and female were divided in the ratio of
as a public health priority (World Health Organization [WHO], 7:3 using the Bernoulli trial. Approximately 70% of the divided
2010). To prevent chronic diseases, continuous healthcare is data (total: n = 319,643, male: n = 147,600, female: n = 172,043)
necessary, which requires the evaluation of HRPF. However, were used in the development of the HRPF estimation formula
measurements of HRPF are often not practical or feasible to with gender, age, BMI, and percent body fat, and approximately
perform in daily life. Additionally, laboratory methods can 30% of the data (total: n = 136,990, male: n = 63,013, female:
accurately measure physical fitness, but may not be a feasible n = 73,977) were used for the validity test. The power test was
approach for entire populations owing to cost, time constraints, performed using G∗ Power 3.1.9.2 (Franz Faul, University of Kiel,
and the need for qualified technicians and sophisticated devices. Kiel, Germany) at the tails of two, the H1 ρ2 of 0.3, the H0
The American College of Sports Medicine suggested that ρ2 of 0, the significant level of 0.05 (α = 0.05), the power of
physical health is a measurable result of an individual’s PA and 0.9, and the number of predictors of 4 for all statistical tests.
exercise habits, which is why many healthcare providers value G∗ Power showed that 51 subjects had sufficient power for this
the accurate and precise measurement of HRPF (Liguori and study. The study was conducted according to the guidelines of
American College of Sports Medicine, 2020). Common HRPF the Declaration of Helsinki and approved by the Institutional
tests include the isometric hand grip strength (HGS) test for Review Board of Kunkuk University (7001355-202101-E-132).
measuring muscle strength (Bäckman et al., 1995), the sit and All individuals provided informed consent before enrollment.
reach test for flexibility (Mier, 2011), the sit-up test for abdominal The population characteristics are presented in Table 1.
muscular endurance (Chen et al., 2020b), and the graded exercise
test for cardiorespiratory endurance (Beltz et al., 2016; Kim et al., Measurement of Dependent Variables
2019b). The association between HRPF and health conditions Height was measured to the nearest 0.1 cm using a stadiometer
has been established in several studies (Mendes et al., 2016; (Seca, Seca Corporation, Columbia, MD, United States). Body
Chrismas et al., 2019; Chen et al., 2020a). Recently, technological weight and percent body fat were measured using bioelectrical

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Kim et al. Estimation of Health-Related Physical Fitness

TABLE 1 | Characteristics of the study population.

Variables Regression model data Validity test data

Total (n = 319,643) Male (n = 147,600) Female (n = 172,043) Total (n = 136,990) Male (n = 63,013) Female (n = 73,977)

Age (years) 38.95 ± 14.91 35.16 ± 14.21 42.20 ± 14.74 38.91 ± 14.89 35.07 ± 14.17 42.18 ± 14.72
Height (cm) 165.42 ± 9.09 172.79 ± 6.25 159.09 ± 5.78 165.40 ± 9.10 172.83 ± 6.24 159.07 ± 5.75
Bodyweight 65.24 ± 12.39 73.57 ± 10.90 58.10 ± 8.54 65.23 ± 12.38 73.55 ± 10.80 58.14 ± 8.67
(kg)
BMI (kg/m2 ) 23.73 ± 3.35 24.61 ± 3.18 22.97 ± 3.30 23.73 ± 3.36 24.60 ± 3.16 23.00 ± 3.34
Percent body 26.45 ± 8.15 21.23 ± 6.65 30.92 ± 6.48 26.48 ± 8.16 21.22 ± 6.64 30.96 ± 6.49
fat (%)
HGS (kg) 31.18 ± 10.39 40.17 ± 7.57 23.47 ± 4.73 31.14 ± 10.38 40.14 ± 7.59 23.47 ± 4.73
Sit and reach 12.00 ± 9.35 8.80 ± 9.42 14.75 ± 8.37 12.01 ± 9.33 8.83 ± 9.41 14.71 ± 8.35
(cm)
Sit-ups (n) 30.57 ± 15.95 40.16 ± 13.73 22.33 ± 12.82 30.56 ± 15.94 40.24 ± 13.67 22.30 ± 12.78
Estimated 36.25 ± 6.74 40.91 ± 5.94 31.95 ± 4.04 36.25 ± 6.77 40.94 ± 5.94 31.91 ± 4.04
VO2max
(ml/kg/min)

Values are expressed as mean ± SD. BMI, body mass index; HGS, hand grip strength; VO2max , maximal oxygen uptake.

impedance analysis equipment (Inbody 720, Inbody, Seoul, on a treadmill (TM55 treadmill, Quinton Cardiology Systems,
Korea) (Jeong et al., 2020). BMI was calculated by dividing body Inc., Seattle, WA, United States). Heart rate was measured using
weight (kg) by height squared (m2 ). a heart rate monitor (Quinton Q-Stress, Quinton Cardiology
Systems, Inc., Bothell, WA, United States). The participants were
Health-Related Physical Fitness expected to reach three of the following criteria: (1) heart rate
reserve >85%; (2) heart rate did not increase even when the
Parameters stage increased; (3) rating of perceived exertion >17 (range:
All HRPF parameters were measured by certified health and 6–20); (4) request to stop by the participant. The VO2max
physical fitness instructors. The HRPF assessment for adults was calculated using the Bruce formula: 6.70 − 2.82 × (1:
included HGS, flexibility (sit and reach), muscular endurance male, 2: female) + (0.056 × exercise maintaining time (s))
(sit-ups), and CRF (estimated VO2max ). Descriptions of the tests (Bruce et al., 1973).
are as follows:
HGS (kg): Isometric muscle strength was assessed using
a hand dynamometer (GRIP-D 5101, Takei, Niigata, Japan). Statistical Analysis
Participants held the dynamometer with their preferred hand and The mean and standard deviation were calculated for all
squeezed it as forcefully as possible. All participants were tested measured parameters. The normality of distribution of all
twice, and the best result was recorded to the nearest 0.1 kg. outcome variables was verified using the Kolmogorov–Smirnov
Sit-and-reach (cm): The participants sat on a mat and placed test. To perform multiple linear regression analysis, the β-value
their feet in front of the measurement board with their legs fully (the regression coefficient) was used to verify if the independent
extended. Participants were directed to gradually reach forward variables had explanatory power (Park et al., 2020). In this
with both hands overlapped and push the bar as far as possible, work we used the stepwise mode of regression analysis,
holding this position for approximately 3 s. The best score was which is indicated when multiple independent variables are
recorded after two trials and recorded to the nearest 0.1 cm. taken as predictors (Shepperd and MacDonell, 2012; Bardsiri
Sit-ups (number of times): The participants laid on a mat with et al., 2014). The stepwise regression technique aims to
their knees bent at 90◦ and their feet held down by a partner. maximize the estimated power with a minimum number of
After being instructed to begin, they raised their upper body until independent variables. Multiple linear regression analysis with
their elbows touched the knees, and then returned to the initial the stepwise technique predicted HRPF parameters (HGS,
position where both shoulders were in contact with the mat. Their flexibility, muscular endurance, and CRF) using dependent
hands were required to remain placed crosswise on the chest variables (e.g., gender, age, body mass index, and percent
during the test. The total number of accurately performed and body fat). In addition, we rigorously conformed to the basic
complete sit-ups was recorded. assumptions of the regression model: linearity, independence,
Estimated VO2max (ml/kg/min): A graded exercise treadmill autocorrelation, homoscedasticity, continuity, normality, and
test with Bruce protocol (Bruce et al., 1973) was applied to outliers. The outlier data in the multiple regression model
measure a VO2max . All participants began walking at a speed were identified and removed when the absolute value of the
of 2.7 km/h, at an inclination of 10%. The speed was increased studentized residual (SRE) was ≥2. The validity of the regression
1.3–1.4 km/h at 3 min intervals, and the incline was increased model was tested using approximately 30% of the total data,
by 2% with each stage. The graded exercise test was performed which had already been divided through the Bernoulli trial, and

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Kim et al. Estimation of Health-Related Physical Fitness

were not included in the development of the regression model. of estimated VO2max regression models was 72.0%, and SEE was
The validation test calculated the predicted values of the HRPF 3.56 ml/kg/min (F = 131291.452, P < 0.001).
parameters using the regression equation, and the mean error
and standard errors of estimation (SEE) were calculated using Performance Evaluation of Regression
formulas 1 and 2. Two-tailed Pearson-correlation analysis was Models and Regression Equations
performed to estimate the relationships between measured and
predicted HRPF parameters. The Statistical Package for the Social
Without Outlier Data
Sciences (SPSS) version 25.0 (IBM Corporation, Armonk, NY, Table 4 shows the results of the multiple regression analysis using
United States) was used for analysis, and the level of significance HRPF parameters without outlier data. The explanatory power
was set at 0.05. of HGS regression models (SRE 27: n = 253,339) was 87.0%,
P Measured value−Predicted value and SEE was 3.27 kg (F = 422009.836, P < 0.001). Moreover,
Measured value ∗100 the explanatory power of the developed sit and reach regression
Mean error (%) = models (SRE 31: n = 263,737) was 29.8%, and SEE was 5.64 cm
N
(F = 28,019.748, P < 0.001). The explanatory power of sit-
Formula 1. The calculation formula for the mean error ups regression models (SRE 34: n = 268,182) was 75.1%, and
(Mesured value−Predicted value)2 SEE was 7.44 n (F = 202,721.241, P < 0.001). In addition,
P
Standard errors of estimation = N−2 the explanatory power of estimated VO2max regression models
Formula 2. The calculation formula for the standard errors of (SRE 44: n = 151,314) was 88.5%, and SEE was 1.77 ml/kg/min
estimation. (F = 290,332.119, P < 0.001).

Regression Model Validity

RESULTS The validity of the developed regression models was calculated
using data not included in multiple regression analyses. In all
For each multiple regression model developed, the F-test regression models of HRPF parameters, the mean error was
was used to validate the significance of the model. Multiple −38.13 to 3.36% (HGS: −4.33%, sit and reach: −14.92%, sit-ups:
regression analyses have shown that the regression coefficients −38.13%, and estimated VO2max : 3.36%), and SEE was higher
for the selected independent variable were statistically significant. than the developed regression model (Table 5).
Multiple regression analyses for each model included coefficients
of determination (R2 ), adjusted coefficients of determination
Relationship Between Measured and
(adjusted R2 ), and SEE. The correlations between the dependent
variables and HRPF parameters are shown in Table 2. Predicted HRPF Parameters
Table 6 displays the relationship between the measured and
Performance Evaluation of Regression predicted HRPF parameters. Measured HRPF parameters were
positively related with predicted HGS (r = 0.841, P < 0.01), sit
Models and Regression Equations and reach (r = 0.391, P < 0.01), sit-ups (r = 0.746, P < 0.01), and
The detailed results of the multiple regression analysis using estimated VO2max (r = 0.848, P < 0.01), as seen in Figure 1.
HRPF parameters are shown in Table 3. The estimated
explanatory power of HGS regression models was 71.0%, and SEE
was 5.60 kg (F = 194,597.062, P < 0.001). Further, the explanatory DISCUSSION
power of the sit and reach regression models was 15.5%, and SEE
was 8.60 cm (F = 14,568.080, P < 0.001). The explanatory power Over the years, the components of HRPF have been established
of sit-ups regression models was 55.5%, and SEE was 10.63 n in various ways in scientific research (Meredith and Welk, 2010).
(F = 98,806.560, P < 0.001). In addition, the explanatory power Previous studies describe HRPF as having a multidimensional
structure despite the many different definitions (Meredith and
Welk, 2010). Some European studies consider HRPF to include
TABLE 2 | Correlation coefficients between dependent variables and HRPF
body composition, musculoskeletal fitness, CRF, and skill-related
parameters for the estimating regression model.
fitness (agility, speed, and coordination) (Artero et al., 2011; Ruiz
Dependent variables HRPF parameters et al., 2011; Secchi et al., 2014). Other studies consider only
body composition, CRF, musculoskeletal fitness, and flexibility
HGS Sit and Sit-ups Estimated (Pillsbury et al., 2013); or body composition, CRF, muscle
reach VO2max
strength, and flexibility as components of HRPF (Castillo-
Gender R −0.802* 0.316** −0.558** −0.665** Garzón et al., 2006). However, the American College of Sports
Age R −0.262** 0.058** −0.523** −0.545** Medicine recommends five factors: body composition, flexibility,
BMI R 0.278** −0.154** −0.057** −0.207** muscular strength, muscular endurance, and CRF (Liguori and
Percent body fat R −0.558** 0.021** −0.626** −0.749** American College of Sports Medicine, 2020). Therefore, multiple
regression analysis using the stepwise technique predicted the
Significant correlation between measured HRPF parameters and dependent
variables. HRPF: health-related physical fitness; BMI: body mass index; HGS: hand HRPF parameters (HGS, flexibility, muscular endurance, and
grip strength; VO2max : maximal oxygen uptake. **P < 0.01. CRF) of the American College of Sports Medicine criteria using

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Kim et al. Estimation of Health-Related Physical Fitness

TABLE 3 | Estimated regression equations predicting HRPF parameters.

Regression model R R2 Adjusted R2 F-value P value SEE

HGS = 35.264 − (9.668 × gender) − (0.513 × percent body 0.842 0.710 0.710 194,597.062 0.000 5.60
fat) + (1.064 × BMI) − (0.044 × age)
Sit and reach = −3.071 + (10.812 × gender) − 0.393 0.155 0.155 14,568.080 0.000 8.60
(0.451 × percent body fat) + (0.397 × BMI) + (0.024 × age)
Sit-ups = 59.556 − (0.933 × percent body fat) − (0.367 × age) 0.745 0.555 0.555 98,806.560 0.000 10.63
+ (0.742 × BMI) − (4.983 × gender)
Estimated VO2max = 62.782 − (0.279 × percent body fat) − 0.848 0.720 0.720 131,291.452 0.000 3.56
(0.135 × age) − (5.555 × gender) − (0.242 × BMI)

HRPF, health-related physical fitness; SEE, standard error of estimation; gender: 1 = male, 2 = female; BMI, body mass index; HGS, hand grip strength; VO2max ,
maximal oxygen uptake.

TABLE 4 | Estimated regression equations predicting HRPF parameters without outlier data.

Regression model R R2 Adjusted R2 F-value P value SEE

HGS (SRE 27: n = 253,339) = 37.138 − (10.190 × gender) + 0.932 0.870 0.870 422,009.836 0.000 3.27
(0.988 × BMI) − (0.457 × percent body fat) − (0.042 × age)
Sit and reach (SRE 31: n = 263,737) = 0.005 + 0.546 0.298 0.298 28,019.748 0.000 5.64
(10.762 × gender) − (0.432 × percent body fat) +
(0.339 × BMI) + (0.009 × age)
Sit-ups (SRE 34: n = 268,182) = 62.443 − (1.015 × percent 0.867 0.751 0.751 202,721.241 0.000 7.44
body fat) − (0.392 × age) + (0.783 × BMI) − (5.287 × gender)
Estimated VO2max (SRE 44: n = 151,314) = 61.068 − 0.941 0.885 0.885 290,332.119 0.000 1.77
(0.197 × percent body fat) − (5.920 × gender) − (0.133 × age)
− (0.305 × BMI)

HRPF, health-related physical fitness; SEE, standard error of estimation; SRE, studentized residual; gender: 1 = male, 2 = female; BMI, body mass index; HGS, hand grip
strength; VO2max , maximal oxygen uptake.

TABLE 5 | Validity of estimating the regression model.

small sample sizes or samples with limited age ranges (Esco
et al., 2008; Shenoy et al., 2012; Lopes et al., 2018; Zaccagni
HGS Sit and reach Sit-ups Estimated VO2max et al., 2020). This study aimed to develop a multiple regression
model for estimating the HRPF parameters in Korean adults
Mean error (%) −4.33 −14.92 −38.13 3.36
using easy-to-measure dependent variables. Before performing
SEE 5.61 kg 8.72 cm 10.65 n 3.92 ml/kg/min
multiple regressions to estimate HRPF parameters, it is essential
SEE, standard error of estimation; HGS, hand grip strength; VO2max , to eliminate outliers because they increase predictive errors. The
maximal oxygen uptake.
absolute value of the studentized residual was used to eliminate
outliers in this study. The coefficient of determination of the
TABLE 6 | Relationship between measured and predicted HRPF parameters. HRPF parameters in the developed multiple regression models
HRPF parameters R P value
was high, except for flexibility. The mean explanatory power of
the sit and reach regression model in our study was 29.8%.
HGS 0.841 0.000** The HGS used to evaluate total muscle strength measures
Sit and reach 0.391 0.000** the ability of hand muscles to produce force (tension) using
Sit-ups 0.746 0.000** a hand dynamometer (Mitsionis et al., 2009). The relevance
Estimated VO2max 0.848 0.000** of HGS measurements continues to grow due to their clinical
Significant correlation between measured and predicted HRPF parameters, and epidemiological application for sarcopenia diagnosis, as
**P < 0.01. HRPF, health-related physical fitness; HGS, hand grip strength; VO2max , suggested by the European Working Group (Cruz-Jentoft et al.,
maximal oxygen uptake. 2010), or as a nutrition status indication and their association
with morbidity and mortality (Norman et al., 2011). HGS
dependent variables (e.g., gender, age, body mass index, and has been studied in relation with various anthropometric
percent body fat). factors (Alahmari et al., 2017; Eidson et al., 2017; Lopes
Many researchers have conducted studies to evaluate health et al., 2018; Zaccagni et al., 2020). In the current study,
conditions and exercise performance using HRPF, while the mean explanatory power of the HGS regression model
assuming that the HRPF parameter is a reliable healthcare (37.138 − (10.190 × gendermale = 1;female = 2 ) + (0.988 × BMI) −
index. For healthcare, the development of tools or equipment (0.457 × percent body fat) − (0.042 × age)) was 87.0% (adjusted
that can easily measure and evaluate HRPF in daily life will R2 ). Alahmari et al. (2017) showed that three variables (i.e.,
be useful. Previous studies developed equations with relatively age, hand length, and forearm circumference) predicted 42.7%

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Kim et al. Estimation of Health-Related Physical Fitness

FIGURE 1 | Relationship between measured or estimated, and predicted HRPF. (A) Hand grip strength. (B) Sit and reach. (C) Sit-ups. (D) VO2max . Significant
correlation between measured or estimated and predicted variables, **P < 0.01.

(adjusted R2 ) of what constitutes the HGS of healthy adult males could be explained by height, push-ups, skinfolds at the thigh,
(aged: 20–74 years; n = 116) in Saudi Arabia. Furthermore, and skinfolds at the subscapularis (1.651 + (0.368 × push-
Zaccagni et al. (2020) reported that the independent variables ups) + (0.495 × height) − (0.277 × skinfolds at the
sex, upper arm muscle area, arm fat index, fat mass, and thigh) − (0.336 × skinfolds at the subscapularis)) in
fat free mass accounted for 74.6% (adjusted R2 ) of the healthy adults (aged: 18–48 years; total: n = 100; male:
variance of HGS in young adults (aged: 18–30 years; total: n = 40; female: n = 60) (Esco et al., 2008). The sit-
n = 544; male: n = 356; female: n = 188). Lopes et al. ups regression model’s (62.443 − (1.015 × percent body
(2018) showed that 71% (adjusted R2 ) of the variability in fat) − (0.392 × age) + (0.783 × BMI) − (5.287 × gendermale
the dominant HGS could be explained by gender, forearm = 1;female = 2 )) mean explanatory power estimated in our study
circumference, and hand length (−15.490 + (10.787 × gender was 75.1% (adjusted R2 ).
male = 1;female = 0) + (0.558 × forearm Cardiorespiratory fitness is an essential component of
circumference) + (1.763 × hand length)). In addition, health and physical fitness, and is affected by the respiratory,
70% (adjusted R2 ) of the variability in the nondominant cardiovascular, and skeletal muscle systems (Liguori and
HGS was explained by gender and hand length American College of Sports Medicine, 2020). The gold standard
(−9.887 + (12.832 × gender male = 1;female = 0 ) + (2.028 × hand measurement of CRF is VO2max when performing a maximum
length)) in young adult and middle-aged participants (aged: graded exercise test (Liguori and American College of Sports
20–60 years; total: n = 80; male: n = 40; female: n = 40). Our study Medicine, 2020). However, while VO2max is the most accurate
confirmed that the regression model formulation developed is way to evaluate CRF, testing requires expensive equipment, space
more accurate and straightforward than the predictive power of to accommodate equipment, and trained personnel. Previous
previous studies. studies developed a method to predict VO2max without exercise
The two most important trunk muscle abilities have been using multiple regression analysis (Bradshaw et al., 2005; Shenoy
presented as trunk muscle strength and muscular endurance et al., 2012). The non-exercise regression equations provide
in both the athletic and general populations (Granacher et al., convenient estimates of CRFs without performing maximum
2013). Trunk muscle strength and muscular endurance testing or submaximal exercise tests (Bradshaw et al., 2005). Shenoy
in clinical fields have been important in injury rehabilitation et al. showed that 79.9% (adjusted R2 ) of the variability in
and prevention programs (Jackson et al., 1998; del Pozo-Cruz VO2max could be explained by gender, perceived functional
et al., 2013). Sit-ups test are known to evaluate strength and ability, and body surface area (−1.541 + (1.096 × gender
muscular endurance in the abdomen (Morrow et al., 2015; male = 1;female = 0 ) + (0.081 × perceived functional
Liguori and American College of Sports Medicine, 2020). ability) + (1.084 × body surface area)) in healthy
Esco et al. showed that 63.7% (R2 ) of the variability in sit-ups young Indian adults (aged: 18–27 years; total: n = 120;

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Kim et al. Estimation of Health-Related Physical Fitness

male: n = 60; female: n = 60) (Shenoy et al., 2012). Bradshaw gender, age, BMI, and percent body fat. A multi-regression
et al. (2005) showed that 87% (R2 ) of the variability in equation could be developed based on these demographic and
VO2max could be explained by gender, age, BMI, perceived anthropometric variables. Since this multi-regression equation
functional ability, and PA rating (48.073 + (6.178 × gender requires only a simple parameter measurement, it could be time-
male = 1;female = 0 ) – (0.246 × age) – (0.619 × BMI) + efficient, inexpensive, and realistic for large groups in clinical
(0.712 × perceived functional ability) + (0.671 × PA rating)) in practice. The prediction equation will allow coaches, athletes,
adults (aged: 18–65 years; total: n = 100; male: n = 50; female: healthcare professionals, researchers, and the general public to
n = 50). In our study, the mean explanatory power of the better estimate the expected HRPF in order to improve the
estimated VO2max regression model (61.068 − (0.197 × percent data interpretation.
body fat) − (5.920 × gendermale = 1;female = 2 ) − (0.133 × age) −
(0.305 × BMI)) was 88.5% (adjusted R2 ). Accordingly, we
obtained similar or higher regression coefficient than previous DATA AVAILABILITY STATEMENT
studies by using independent variables that are more accessible
to measure, and a larger sample size. Therefore, we consider the The original contributions presented in the study are included
results of this study straightforward and accurate. in the article/Supplementary Material, further inquiries can be
directed to the corresponding author.

LIMITATIONS
ETHICS STATEMENT
This study had some limitations. The role of HRPF and nutrition
in decreasing the progression of chronic diseases is growing The studies involving human participants were reviewed and
more important (Gil et al., 2015). Nutrition was described as a approved by Institutional Review Board of Kunkuk University.
major modifiable behavior, and HRPF has also been defined as Written informed consent for participation was not required for
an essential health-related indication (Camões and Lopes, 2008). this study in accordance with the national legislation and the
Previous studies have shown that improvements in HRPF and institutional requirements.
nutritional factors could prevent functional limitations related
to aging, lead to healthier and independent aging processes
(Strandberg et al., 2017; Wickramasinghe et al., 2020). However, AUTHOR CONTRIBUTIONS
the association with HRPF parameters could not be evaluated
because the NFA database did not provide nutrition information. S-WK, HJ, JL, and H-YP: conception and study design. S-WK,
We only included adults between the ages of 19 and 64 HJ, and H-YP: statistical analysis. H-YP: investigation. S-WK and
in our analysis. Therefore, the multiple regression equation H-YP: data interpretation and writing–review and editing. S-WK:
developed in the present study does not apply to older adults. writing–original draft preparation. KL: supervision. All authors
In the future, a multi-regression equation development study have read and approved the final manuscript.
will be necessary to predict the functional physical fitness
of older adults.
FUNDING
CONCLUSION This research was supported by the Sports Promoting Fund of the
Korea Sports Promotion Foundation (KSPO) from the Ministry
This study demonstrated that the variability of HGS, muscular of Culture, Sports and Tourism and Konkuk University (KU)
endurance, and CRF in healthy adults could be explained by Research Professor Program.

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Strandberg, T., Levälahti, E., Ngandu, T., Solomon, A., Kivipelto, M., Lehtisalo, absence of any commercial or financial relationships that could be construed as a
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doi: 10.1016/j.eurger.2016.12.005 Copyright © 2021 Kim, Park, Jung, Lee and Lim. This is an open-access article
Warburton, D. E., Nicol, C. W., and Bredin, S. S. (2006). Health benefits of physical distributed under the terms of the Creative Commons Attribution License (CC BY).
activity: the evidence. CMAJ 174, 801–809. doi: 10.1503/cmaj.051351 The use, distribution or reproduction in other forums is permitted, provided the
Wickramasinghe, K., Mathers, J. C., Wopereis, S., Marsman, D. S., and Griffiths, original author(s) and the copyright owner(s) are credited and that the original
J. C. (2020). From lifespan to healthspan: the role of nutrition in healthy ageing. publication in this journal is cited, in accordance with accepted academic practice. No
J. Nutr. Sci. 9:e33. doi: 10.1017/jns.2020.26 use, distribution or reproduction is permitted which does not comply with these terms.

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