CC BY
120
DEPENDENCE OF MUSCLE STRENGTH ON BIOLOGICAL MATURATION RATES AND KEY VARIABLES OF PHYSICAL DEVELOPMENT IN TEENAGE BOYS
Milushkina OYu1, Skoblina NA1, Prusov PK2>3, Bokareva NA1E3, Tatarinchik AA1, Kozyreva FU1, Moiseev AB4
1 Department of Hygiene, Faculty of Pediatrics,
Pirogov Russian National Research Medical University, Moscow, Russia
2 Department of Restorative, Sports and Health Resort Medicine and Physiotherapy,
Institute of Advanced Training of the Federal Medical-Biological Agency of the Russian Federation, Moscow, Russia
3 Moscow Centre for Research and Practice in Medical Rehabilitation, Restorative and Sports Medicine, Moscow, Russia
4 Department of Propedeutics of Childhood Diseases, Faculty of Pediatrics, Pirogov Russian National Research Medical University, Moscow, Russia
Functional abilities of school-age children are affected by a variety of factors, including endogenous. Over the course of a few years, we studied physical development of 182 boys who underwent annual physical examination from the age of 11 to 17. We took basic anthropometric measurements, such as height and weight, tested hand muscle strength and assessed biological maturation and body build. Our study showed that muscle strength in school-age boys suffers a negative influence of such endogenous factors as delayed physical development, body mass deficit, short stature, and asthenic build. Excess weight and low skeletal weight also contribute to decreased muscle strength in teenage boys. Our results can be used to identify teenagers at risk who should be given special attention during PE classes at school or during training sessions before the GTO fitness test.
Keywords: physical development of school-age children, biological maturation rate, hand muscle strength, handgrip test, somatotype
[X] Correspondence should be addressed: Natalia Bokareva
ul. Ostrovityanova, d. 1, Moscow, Russia, 117997; [email protected]
Recieved: 23.10.2017 Accepted: 15.11.2017
ЗАВИСИМОСТЬ МЫШЕЧНОЙ СИЛЫ ОТ ТЕМПОВ БИОЛОГИЧЕСКОГО СОЗРЕВАНИЯ И ОСНОВНЫХ ПОКАЗАТЕЛЕЙ ФИЗИЧЕСКОГО РАЗВИТИЯ У МАЛЬЧИКОВ-ПОДРОСТКОВ
О. Ю. Милушкина1, Н. А. Скоблина1, П. К. Прусов2,3, Н. А. Бокарева1 ^ А. А. Татаринчик1, Ф. У. Козырева1, А. Б. Моисеев4
1 Кафедра гигиены, педиатрический факультет,
Российский национальный исследовательский медицинский университет имени Н. И. Пирогова, Москва
2 Кафедра восстановительной медицины, ЛФК и спортивной медицины, курортологии и физиотерапии, Институт повышения квалификации ФМБА России, Москва
3 Московский научно-практический центр реабилитации, восстановительной и спортивной медицины, Москва
4 Кафедра пропедевтики детских болезней педиатрического факультета, Российский национальный исследовательский медицинский университет имени Н. И. Пирогова, Москва
На формирование функциональных возможностей современных школьников влияют различные факторы, в том числе эндогенные. В статье представлены данные об особенностях физического развития 182 мальчиков, каждого из которых обследовали ежегодно с 11 до 17 лет. Изучали основные антропометрические показатели (длину и массу тела), функциональные показатели (мышечную силу кистей рук), показатели биологического развития и особенности телосложения. Исследование показало, что негативное влияние на формирование мышечной силы у мальчиков-подростков оказывает ряд эндогенных факторов: задержка биологического развития, дефицит массы тела, рост ниже среднего и астеноидный тип телосложения. На формировании мышечной силы мальчиков-подростков неблагоприятно сказываются также избыточная масса тела и низкая скелетная масса. Полученные данные позволяют выделить группу риска, детям из которой следует уделять особое внимание при занятиях физкультурой и спортом и при подготовке к сдаче норм ГТО.
Ключевые слова: физическое развитие школьников, темп биологического созревания, мышечная сила кистей рук, динамометрия, соматотипы
Для корреспонденции: Бокарева Наталия Андреевна
ул. Островитянова, д. 1, г Москва, 117997; [email protected]
Статья получена: 23.10.2017 Статья принята к печати: 15.11.2017
Hand grip strength reflects muscular and nervous health of an individual. Hand grip tests have long been used to assess the functional capacity and physical strength of children during regular medical checkups or pre-training consultations. Studies
of physical capacity are becoming increasingly important in light of Order 172 of the President of the Russian Federation dated March 24, 2104 On the Nationwide Fitness Program GTO (GTO stands for Ready for Labor and Defense).
There is evidence of new trends in the physical development of children and teenagers towards a larger overall body size, accelerated biological maturation, earlier menarche, and overweight [1-9], as well as reduced functional capacities, including decreased muscle strength [10-13]. In the majority of studies dynamometry scores are analyzed in the context of social and environmental factors [14, 15]. However, the correlation between muscle strength and the physical development of children and teenagers accounting for the population variability remains understudied.
In this work we aimed to investigate how hand muscle strength correlates with physical development and the rate of biological maturation.
METHODS
This longitudinal study recruited 182 Moscow-born Caucasian teenage boys. The boys underwent physical examinations annually, from the time they were 11 till they turned 17 years of age. In terms of general health, the participants fell into health categories 1 and 2.
Physical development and biological maturity of the participants were assessed using a unified anthropometric method and standard techniques [16]. Basic anthropometric measurements were taken (body weight and height) and a functional right-hand grip test was conducted. To assess how balanced the physical development was, we did weight to height scaling using a modified regression technique [17]. Somatoscopy included visual assessment of biological maturity. Based on the maturation rate, the boys were classified as retarded in physical development (biological age lagged behind chronological age); normally developing (biological age coincided with chronological age); and accelerated in their physical development (biological age was ahead of chronological age).
Body build was classified using Darskaya's modification (1975) of the method proposed by Shtephko and Ostrovsky in 1929. Based on the visual assessment of the muscle bulk, bone skeleton, subcutaneous fat distribution, thorax shape, abdomen, back, and legs, we discriminated between the abdominal, thoracic, muscular, asthenic and mixed somatotypes [16].
Table 1. Correlations between the main parameters of physical development and hand muscle strength of 11-year-old boys (r; p < 0.05)
Associations between muscle strength and muscle/fat mass were studied in 23 boys. Somatometric measurements were taken using conventional anthropometric methods and techniques. Body composition was analyzed on the InBody device (South Korea) for bioelectrical impedance analysis.
Statistical processing was performed using Statistica 6.0 (StatSoft, USA). To estimate significance of differences, Student's t test was applied. Correlations were studied between qualitative characteristics of physical development using Pearson's linear correlation coefficient r to describe correlation strength. At r< ± 0.3, the correlation was either absent or weak; at r ranging from ± 0.5 to ± 0.7 the correlation was moderate; at r> ± 0.7 the correlation was strong.
The study was approved by the Ethics Committee of Pirogov Russian National Research Medical University (Protocol 130 dated December 9, 2013). Informed consent was obtained from the parents and headmasters.
RESULTS
The correlation analysis showed that there was a statistically significant (p<0.05) moderate correlation between muscle strength and body height in 11-year old boys; the correlation between muscle strength and body weight also turned out to be significant in this age group. It should be noted that correlation strength declined as the boys grew older (Tables 1, 2).
More pronounced correlations were observed in impedance tests. The analysis revealed the presence of statistically significant (p<0.05) strong correlations between muscle strength and basal metabolism parameters (r = 0.86) and skeleton mass (r = 0.86). Moderate negative correlations were detected between muscle strength and fat mass (r = -0.52, p < 0.05).
Table 3 presents data on the hand muscle strength of boys grouped by their age. As the boys grew older, muscle strength increased from 15.25 ± 0.86 kg at 11 years of age to 38.66 ± 0.8 kg at 17 years of age, i.e. 2.5 times.
Figure 1 shows age-related dynamics of muscle strength in teenage boys depending on the rate of biological maturation.
The boys whose physical development was accelerated had better muscle strength at the age of 11, scoring even more by the age of 13, in comparison with their peers retarded in
Table 2. Correlations between the main parameters of physical development and hand muscle strength of 17-year-old boys (r; p < 0,05)
Parameter Height Weight Right hand muscle strength
Height 1 0.75 0.53
Weight 0.75 1 0.47
Right hand muscle strength 0.53 0.47 1
Parameter Height Weight Right hand muscle strength
Height 1 0.56 0.47
Weight 0.56 1 0.39
Right hand muscle strength 0.47 0.39 1
Table 3. Age-related dynamics of muscle strength in boys aged 11 to 17 years (M ± m)
Age, years 11 12 13 14 15 16 17
Muscle strength, kg 15,15 ± 0,26 16,85 ± 0,30 19,93 ± 0,58 26,08 ± 0,69 31,49 ± 0,68 35,13 ± 0,60 37,50 ± 0,74
Table 4. Muscle strength In boys belonging to different somatotypes (M ± m)
Parameter Somatotype
asthenic thoracic muscular abdominal mixed
1 2 3 4 5
Right hand muscle strength 14.3 ± 0.2 17.04 ± 0.1 18.3 ± 0.2 18.6 ± 0.3 16.2 ± 0.2
p-value p < 0.05 when comparing 1 and 3; p < 0.01 when comparing 1 and 4
physical development. The highest scores in this group were seen at the age of 17. At 11 or 12 years of age, the boys whose development was retarded did not differ significantly from normally developing teenagers in terms of muscle strength, but at 13-15 years they scored less than normally developing or accelerating children. By the age of 16-17, these differences were leveled out and became unreliable.
Figure 2 shows how muscle strength depends on the physical development of the participants (body mass). In all age groups, no significant differences were observed in terms of
muscle strength between normally developing and overweight children. The value of the muscle strength of boys with weight deficiency in all age groups except for 14 year old teenagers was significantly lower than that of harmoniously developing children (p<0.01, p<0.05, respectively).
We also discovered that muscle strength was dependent on body height. In all age groups, muscle strength of teenagers who were shorter than the average was significantly weaker than in other boys (p < 0.01, p < 0.05; see Table 3). The boys who were taller than the average or just tall scored better in
45
40
35
30
25
ö 20
15
Retarded development Normal development Accelerated development
10
5
11 12 13 14 15 16 17
Age, years
Fig. 2. Parameters of muscle strength of teenage boys depending on weight * — p < 0.05, ** - p < 0.01
NPD — normal physical development, WD — weight deficiency, OW — overweight.
40
35 -
30
25 -
ö 20 -
Height:
■ Below average
■ Average
■ Above average
■ Tall
14
Age, years
Fig. 3. Parameters of muscle strength of teenage boys depending on height * — p < 0,05, ** — p < 0,01.
11.1
30.9
Asthenic
Thoracic
Muscular
Abdominal
Mixed
18.6
Fig. 4. Percentage of schoolchildren with different builds
hand grip tests than their peers at 11-16 years of age and 11-14 years of age, respectively (p < 0.01). In older age groups these differences were insignificant.
Somatotyping (Fig. 4) revealed that 42 % of boys belonged to the weak types (asthenic and thoracic); 25.8 % of the participants belonged to the relatively strong (muscular and abdominal) types; 32.2 % had mixed somatotypes. The analysis of muscle strength in children with different somatotypes showed that a somatotype significantly affects muscle strength. Asthenic children scored less than their peers who belonged to the muscular and abdominal types.
DISCUSSION
Studies conducted in different regions of our country are evident of a downward trend in muscle strength in modern children
and teenagers. It has been established that in the Moscow region both boys and girls have worse dynamometry scores in comparison with the children tested in the 1960s and 1980s, and these differences are significant (p < 0.01) [15]. Low values of parameters reflecting the functional capacity of children mean that these children may not be able to meet the GTO requirements, risking their health or even life when attempting to pass this fitness test.
Among endogenous factors affecting muscle strength are the rate of biological maturation and body build [18-20]. Our findings demonstrate that decelerated rates of biological development and asthenic builds negatively affect muscle strength in teenage boys. In our study, average values of muscle strength in teenagers retarded in their physical development at the age of 13 to 15 were significantly lower than in other groups. At the same time, those boys had caught up with their peers in terms of muscle strength by the age
of 17. Dynamometric measurements in boys with the asthenic somatotype demonstrated significantly lower values than in those with the muscular and abdominal types.
While analyzing the influence of other endogenous factors on muscle strength in teenagers and children, we found out that (im)balanced physical development and height (stature) also affect the studied parameter. Boys with weight deficiency and shorter than average height in all age groups scored less than others in terms of muscle strength. In our sample there were no really short boys but we assume they also have reduced functional abilities.
Research studies suggest that about 40 % of all high-school children nowadays may not be able to pass the GTO fitness test [21-25], which brings the need for improving physical education at schools. Based on our findings, we can identify a group at a risk of reduced functional abilities. This group includes boys of asthenic body type, those with weight
deficiency, short height and also teenagers retarded in their biological development at puberty. Teenagers at risk should receive special attention during PE classes at school and in the run up for GTO.
CONCLUSIONS
The conducted study has detected a negative effect of a few endogenous factors on the muscle strength of teenage boys, including retarded biological development, weight deficiency, short height, and the asthenic build. Muscle strength is also affected by high fat and low skeleton masses.
The obtained results have allowed us to identify a group at a risk of reduced functional capacities and to propose practical recommendations aimed at facilitating normal physical development of schoolchildren, that can be used by medical workers, teachers, parents and children themselves.
References
1. Godina EZ, Khomyakova IA, Zadorozhnaya LV, Anisimova AV, Ivanova EM, Permyakova EYu, et al. [Auxological investigations at Mikhailo Lomonosov motherland]. Vestnik Moskovskogo universiteta. Seriya XXIII. Antropologiya. 2011; (3): 68-99. Russian.
2. Povargo EA, Zulkarnaeva AT, Zulkarnaev TR, Ovsyannikova LB, Agafonov AI, Akhmetshina RA. [Regional features of the physical development of schoolchildren in the city of Ufa]. Gigiena i sanitariya. 2014; 93 (4): 72-4. Russian.
3. Perevoshchikova NK, Anisimova AV, Torochkina GP, Koskina EV, Chernych NS. [Dynamics of physical development of schoolchildren Kemerovo for 50 years (the period 1962-2012)]. Mat' i ditya v Kuzbasse. 2014; (1): 4-9. Russian.
4. Gritsinskaya VL, Beketova EV. Analiz fizicheskogo razvitiya shkol'nikov Krasnoyarskogo kraya. In: Materialy XVI Kongressa pediatrov Rossii s mezhdunarodnym uchastiem "Aktual'nye problemy pediatry"; 2012 Feb 24-27; Moscow, Russia. Moscow, 2012. p. 179. Russian.
5. Muratova AP, Karpunov AA. Osobennosti fizicheskogo razvitiya detey i podrostkov Nenetskogo avtonomnogo okruga. In: Tsirkumpolyarnaya meditsina: vliyanie faktorov okruzhayushchey sredy na formirovanie zdorov'ya cheloveka: Materialy mezhdunarodnoy nauchno-prakticheskoy konferentsii; 2011 Jun 27-29; Arkhangelsk, Russia. Arkhangelsk: NSMU Press; 2011. p. 234-40. Russian.
6. Platonova AG. [Changes in the physical development of Kiev schoolchildren over a ten-year period (1996-2008)]. Gigiena i sanitariya. 2012; (2): 69-73. Russian.
7. Lebed'kova SE, Vivtanenko TV, Ignatova TN, Trusova OYu. Rasprostranennost' izbytochnoy massy tela i ozhireniya u detey i podrostkov Orenburga. In: Materialy XVI Kongressa pediatrov Rossii s mezhdunarodnym uchastiem "Aktual'nye problemy pediatry"; 2012 Feb 24-27; Moscow, Russia. Moscow, 2012. p. 192. Russian.
8. Fedotov DM. Formirovanie morfofunktsional'nogo statusa detskogo naseleniya Kraynego Severa na primere Arkhangel'skoy oblasti [abstract of the dissertation]. Moscow: N. I. Pirogov RNRMU; 2013. 22 p. Russian.
9. Bokareva NA, Skoblina NA, Milushkina OYu. [Changes in Physical and Biological Development: Survey on Moscow School Students]. Doktor.Ru. Pediatriya Gastroenterologiya. 2014; 99 (11): 5-8. Russian.
10. Kuchma VR, Skoblina NA, Milushkina OJu, Bokareva NA, Jampol'skaya JuA. [Characteristics of morphofunctional indicators of Moscow schoolchildren aged 8-15 years (on the results of longitudinal studies)]. Vestnik Moskovskogo universiteta. Seriya XXIII. Antropologiya. 2012; (1): 76-83. Russian.
11. Chagaeva NV, Popova IV, Tokarev AN, Kashin AV, Belyakov VA.
[Comparative characteristics of the physiometric parameters of schoolchildren' physical development]. Gigiena i sanitariya. 2011; (2): 72-5. Russian.
12. Kuznetsova DA, Sizova EN, Tulyakova OV. [Functional status of teenagers in consideration of high latitudes]. Sotsial'nye aspekty zdorov'ya naseleniya [serial on the Internet]. 2012 [cited 2017 Sep 28]; 25 (3) [about 7 p.]. Available from: http://vestnik.mednet.ru/ content/view/412/30/lang,ru/. Russian.
13. Smirnova AV, Khasanova AR. Dynamics of some functional indicators of school students Naberezhnye Chelny. Siberian Journal of Life Sciences and Agriculture. 2014; 49 (1): 398-403.
14. Milushkina OYu. Zakonomernosti formirovaniya morfofunktsional'nykh pokazateley detey i podrostkov v sovremennykh sanitarno-gigienicheskikh i mediko-sotsial'nykh usloviyakh [abstract of the dissertation]. Moscow: N. I. Pirogov RNRMU; 2013. 47 p. Russian.
15. Milushkina OYu, Bokareva NA. [The characteristics of development of morpho-functional conditions of modern school children]. Zdravookhranenie Rossiyskoy Federatsii. 2013; (5): 378. Russian.
16. Baranov AA, Kuchma VR, editors. Metody issledovaniya fizicheskogo razvitiya detey i podrostkov v populyatsionnom monitoringe: Rukovodstvo dlya vrachey. Moscow: Soyuz pediatrov Rossii; 1999. 225 p. Russian.
17. Kuchma VR, Sukhareva LM, Khramtsov PI, Zvezdina IV, Krymskiy EF, Rapoport IK, et al. Rukovodstvo po diagnostike i profilaktike shkol'no obuslovlennykh zabolevaniy, ozdorovleniyu detey v obrazovatel'nykh uchrezhdeniyakh. Moscow: SCCH of the RAMS; 2012. p. 144-70. Russian.
18. Fedotova TK. [Peculiarity of somatic state forming in the age 7-16 years old]. Pediatriya. Zhurnal im. G. N. Speranskogo. 2005; (5): 92-4. Russian.
19. Mishkova TA. Morfofunktsional'nye osobennosti i adaptatsionnye vozmozhnosti sovremennoy studencheskoy molodezhi v svyazi s otsenkoy fizicheskogo razvitiya [abstract of the dissertation]. Moscow: Lomonosov Moscow State University, 2010. 24 p. Russian.
20. Boboshko IE. Sistemnyy analiz konstitutsional'nykh osobennostey detey shkol'nogo vozrasta i differentsirovannye programmy formirovaniya ikh zdorov'ya [abstract of the dissertation]. Ivanovo: IvSMA; 2010. 46 p. Russian.
21. Abasov RG, Gorelik VV. Otsenka fizicheskogo razvitiya uchashchikhsya na sootvetstvie normam GTO. Nauka i obrazovanie: novoe vremya. 2017; 18 (1): 52-7. Russian.
22. Kizlyaeva EYu. Sostoyanie zdorov'ya i fizicheskaya podgotovlennost' shkol'nikov dlya sdachi norm GTO. In: Problemy fizicheskoy kul'tury, sporta i turizma v svete sovremennykh issledovaniy i sotsial'nykh protsessov: sbornik trudov
Mezhdunarodnoy nauchno-prakticheskoy konferentsii; 2017 Apr 14; Saint Petersburg, Russia. Saint Petersburg: SPbSUlTD; 2017. p. 461-4. Russian.
23. Shakirova ChR, Nikitin AS, Gulyakov AA. Uroven' gotovnosti uchashchikhsya starshego shkol'nogo vozrasta k sdache norm GTO. In: Materialy Shestoy Vserossiyskoy nauchnoy konferentsii s mezhdunarodnym uchastiem "Olimpiyskaya ideya segodnya";
2016 Apr 20-23; Rostov-on-Don, Russia. Rostov-on-Don: SFEDU Press; 2016. p. 296-302. Russian. 24. Vinogradov IG, Tokareva AV. Training of students with low level of physical fitness to qualifying in standards of "Ready for Labor and Defense". Uchenye zapiski Universiteta imeni P. F. Lesgafta. 2016; 134 (4): 47-51. Russian.
Литература
1. Година Е. З., Хомякова И. А., Задорожная Л. В., Анисимо-ва А. В., Иванова Е. М., Пермякова Е. Ю. и др. Ауксологичес-кие исследования на родине М. В. Ломоносова. Вестн. МГУ. Сер. XXIII. Антропол. 2011; (3): 68-99.
2. Поварго Е. А., Зулькарнаева А. Т., Зулькарнаев Т. Р., Овсянникова Л. Б., Агафонов А. И., Ахметшина Р. А. Региональные особенности физического развития школьников Уфы. Гиг. и сан. 2014; 93 (4): 72-4.
3. Перевощикова Н. К., Анисимова А. В., Торочкина Г. П., Кось-кина Е. В., Черных Н. С. Динамика физического развития школьников г Кемерово за 50 лет (период 1962-2012 гг.). Мать и дитя в Кузбассе. 2014; (1): 4-9.
4. Грицинская В. Л., Бекетова Е. В. Анализ физического развития школьников Красноярского края. В сб.: Материалы XVI Конгресса педиатров России с международным участием «Актуальные проблемы педиатрии»; 24-27 февраля 2012 г.; Москва, Россия. М., 2012. с. 179.
5. Муратова А. П., Карпунов А. А. Особенности физического развития детей и подростков Ненецкого автономного округа. В сб.: Циркумполярная медицина: влияние факторов окружающей среды на формирование здоровья человека: Материалы международной научно-практической конференции; 27-29 июня 2011 г.; Архангельск, Россия. Архангельск: Изд-во СГМУ; 2011. с. 234-40.
6. Платонова А. Г. Изменения в физическом развитии киевских школьников за десятилетний период (1996-2008 гг.). Гиг. и сан. 2012; (2): 69-73.
7. Лебедькова С. Е., Вивтаненко Т. В., Игнатова Т. Н., Трусо-ва О. Ю. Распространенность избыточной массы тела и ожирения у детей и подростков Оренбурга. В сб.: Материалы ХVI Конгресса педиатров России с международным участием «Актуальные проблемы педиатрии»; 24-27 февраля 2012 г.; Москва, Россия. М., 2012. с. 192.
8. Федотов Д. М. Формирование морфофункционального статуса детского населения Крайнего Севера на примере Архангельской области [автореф. диссертации]. М.: РНИМУ им. Н. И. Пирогова; 2013. 22 с.
9. Бокарева Н. А., Скоблина Н. А., Милушкина О. Ю Динамика физического и биологического развития московских школьников. Доктор.Ру. Педиатрия Гастроэнтерология. 2014; 99 (11): 5-8.
10. Кучма В. Р., Скоблина Н. А., Милушкина О. Ю., Бокарева Н. А., Ямпольская Ю. А. Характеристика морфофункци-ональных показателей московских школьников 8-15 лет (по результатам лонгитудинальных исследований). Вестн. МГУ. Сер. XXIII. Антропол. 2012; (1): 76-83.
11. Чагаева Н. В., Попова И. В., Токарев А. Н., Кашин А. В., Беляков В. А. Сравнительная характеристика физиометрических показателей физического развития школьников. Гиг. и сан. 2011; (2): 72-5.
12. Кузнецова Д. А., Сизова Е. Н., Туляков О. В. Функциональное состояние подростков с учетом влияния высоких широт. Социальные аспекты здоровья населения: электрон. науч.
журн. [Интернет]. 2012 [цата обращения: 28 сентября 2017 г.]; 25 (3) [примерно 7 с.]. Доступно по: http://vestnik.mednet. ru/content/view/412/30/lang,ru/.
13. Смирнова А. В., Хасанова А. Р. Динамика некоторых функциональных показателей школьников г Набережные Челны. В мире научных открытий. 2014; 49 (1): 398-403.
14. Милушкина О. Ю. Закономерности формирования мор-фофункциональных показателей цетей и поцростков в современных санитарно-гигиенических и мецико-социальных условиях [автореф. диссертации]. М.: РНИМУ им. Н. И. Пирогова; 2013. 47 с.
15. Милушкина О. Ю., Бокарева Н. А. Особенности формирования морфофункционального состояния современных школьников. Зцравоохр. РФ. 2013; (5): 37-8.
16. Баранов А. А., Кучма В. Р., редакторы. Методы исследования физического развития детей и подростков в популяционном мониторинге: Руководство для врачей. М.: Союз педиатров России; 1999. 225 с.
17. Кучма В. Р., Сухарева Л. М., Храмцов П. И., Звездина И. В., Крымский Е. Ф., Рапопорт И. К. и др. Руководство по диагностике и профилактике школьно обусловленных заболеваний, оздоровлению детей в образовательных учреждениях. М.: НЦЗД РАМН; 2012. с. 144-70.
18. Федотова Т. К. О специфике формирования соматического статуса детей от 7 до 16 лет. Педиатрия. 2005; (5): 92-4.
19. Мишкова Т. А. Морфофункциональные особенности и адаптационные возможности современной студенческой молодежи в связи с оценкой физического развития [автореф. диссертации]. М.: МГУ имени М. В. Ломоносова, 2010. 24 с.
20. Бобошко И. Е. Системный анализ конституциональных особенностей детей школьного возраста и дифференцированные программы формирования их здоровья [автореф. диссертации]. Иваново: ИвГМА; 2010. 46 с.
21. Абасов Р. Г., Горелик В. В. Оценка физического развития учащихся на соответствие нормам ГТО. Наука и образование: новое время. 2017; 18 (1): 52-7.
22. Кизляева Е. Ю. Состояние здоровья и физическая подготовленность школьников для сдачи норм ГТО. В сб.: Проблемы физической культуры, спорта и туризма в свете современных исследований и социальных процессов: сборник трудов Международной научно-практической конференции; 14 апреля 2017 г.; Санкт-Петербург, Россия. СПб.: СПбГУПТД; 2017. с. 461-4.
23. Шакирова Ч. Р., Никитин А. С., Гуляков А. А. Уровень готовности учащихся старшего школьного возраста к сдаче норм ГТО. В сб.: Материалы Шестой Всероссийской научной конференции с международным участием «Олимпийская идея сегодня»; 20-23 апреля 2016 г.; Ростов-на-Дону, Россия. Ростов-на-Дону: Изд-во ЮФУ; 2016. с. 296-302.
24. Виноградов И. Г., Токарева А. В. Тренировка студентов с низким уровнем физической подготовленности к сдаче норм ГТО. Уч. зап. Ун-та им. П. Ф. Лесгафта. 2016; 134 (4): 47-51.
