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International Journal of Health Sciences and Research
DOI: https://doi.org/10.52403/ijhsr.20210703
Vol.11; Issue: 7; July 2021
Website: www.ijhsr.org
Original Research Article ISSN: 2249-9571
Correlation between Body Mass Index (BMI) and
Chest Expansion Values in Young Adult Females: A
Cross Sectional Study
Divya Sharma1, Prajakta Tilaye2
1
BPTh, KJ Somaiya College of Physiotherapy, Sion, Mumbai, India
2
MPTh in Cardiopulmonary Physiotherapy, Assistant Professor, Department of Cardiopulmonary
Physiotherapy, KJ Somaiya College of Physiotherapy, Sion, Mumbai, India
Corresponding Author: Divya Sharma
ABSTRACT
Worldwide, non communicable diseases such as obesity, metabolic syndrome etc. are on the rise. An
increased adiposity due to obesity has several systemic adverse effects, including those on the
respiratory system. Physiotherapists have an essential role in the management of obesity by means of
fitness training and medically supervised exercise programs. The objective of this study was to
understand the direct correlation between Body Mass Index (BMI) and chest expansion. The chest
expansion was evaluated using cloth tape measurement technique at 3 reference levels- axilla, nipple
and xiphisternum. Data from 59 subjects, young adult females (aged 18-24 years) was collected and
analysed. A weak negative correlation was obtained, which was not statistically significant. (p >
0.05). A direct correlation may thus be difficult to establish between the two variables and other
confounding factors must be considered.
Keywords- Body Mass Index (BMI), Chest expansion, Obesity, Correlation, Young adults, cross
sectional
INTRODUCTION with obesity may suffer from a wide range
In the recent years, due to unhealthy of psychosocial issues in addition to their
lifestyle habits such as physical inactivity, musculoskeletal, respiratory, cardiovascular,
imbalanced diet, alcohol consumption, digestive and metabolic issues and thus their
stress, smoking, etc., the overall global quality of life may be affected.[4-5] Haomio
incidence of non-communicable diseases Jia & Erica I. Lubetkin studied the impact of
such as obesity, hypertension, diabetes obesity on health-related quality of life in
mellitus, metabolic syndrome, the general adult US population. It was
cardiovascular diseases, cancer and stroke is found that subjects with obesity experienced
on the rise.[1] Obesity is a chronic metabolic more unhealthy days, associated with
disorder characterized by increased reduced participation in ADLs, and
adiposity in the peripheral and visceral impaired mental health, thus significantly
regions of the body.[2] It was earlier affecting the quality of life. Another study
considered to be a disease of adulthood, but by Katherine M. Morrison et.al. studied the
is now on the rise in young adults and relationship between depression and health
children as well.[1-2] The effects of obesity related quality of life with body composition
on every system are well known, and it is, in in children and youth with obesity. It was
itself, a risk factor for many systemic found that 36.4% of the population with
complications later in adulthood.[2-3] People
International Journal of Health Sciences and Research (www.ijhsr.org) 17
Vol.11; Issue: 7; July 2021Divya Sharma et.al. Correlation between body mass index (BMI) and chest expansion values in young adult
females: a cross sectional study.
obesity also had association with regarding lung compliance, it requires
depression. sophisticated equipment of spirometry,
Obesity adversely affects the which is not always feasible and is
respiratory system by causing a decrease in expensive to use. Also, it does not
both, the lung as well as chest wall selectively study reduction in chest wall
compliance. As the adiposity in the lower compliance.[7-8]
thoracic and upper abdominal region Measurement of chest expansion by
increases, there is reduction in the normal tape method is a simple, reliable, bed side
excursion of diaphragm. This leads to clinical assessment technique to assess the
reduced lung volumes leading to increased chest wall mobility.[10-12] It can be used as a
work of breathing. In the long run, there is tool for documentation during fitness
reduced lung compliance, and therefore evaluation of clients, and serial
obesity acts as a restrictive lung disorder.[2- measurements at regular intervals can be
3,6]
At the same time, due to increased used to evaluate the overall prognosis and
adiposity over the thoracic cage,[6] there is improvement in the chest wall mobility of
increase in work of breathing. The obese subjects following the prescription of
respiratory muscles are forced to work more comprehensive exercise protocols (that
in obese subjects as compared to include aerobics, breathing exercises, yoga,
counterparts with normal Body Mass Index resistance exercises, etc.)
(BMI). This leads to reduced chest wall Dayla Sgariboldi et. al. carried out a
mobility due to reduced muscle efficiency in study to evaluate the influence of age,
the long run.[7-8] anthropometric characteristics and body fat
The compliance of the respiratory distribution on women’s thoracic mobility.
system was studied by Naimark and R.M They concluded that thoracic mobility
Cherniack in 24 normal and 12 obese decreases with age and obesity [6]. However,
subjects. Using spirometry, the lung the study included participants over a wide
volumes and capacities were measured. The age criteria (25-75 years). Age can be a
results of this study showed that total significant confounding variable while
respiratory compliance was reduced in determining the effect of increased Body
obese individuals. An increase in the Mass Index (BMI) on chest expansion, and
mechanical work of breathing was also therefore, we have considered only young
shown in obese individuals. adult females (18-24 years) as a part of our
As physiotherapists, we have an study, in order to better evaluate the effect
important role in management and of Body Mass Index (BMI) on the chest
prevention of the musculoskeletal and expansion. Moreover, very few studies have
cardiorespiratory complications of obesity been carried out in young adult females in
by means of exercise prescription and order to study the correlation of obesity with
training. Safe and optimal training demands chest expansion values using tape
an adequate physiological response to the measurement.[6] Most studies have used
exercise.[9] Altered chest wall mobility and spirometry to study effects of obesity on
reduced lung volumes due to increased lung volumes.[8] Therefore, the results of
adiposity may compromise respiratory this study will help in better understanding
function and subsequent physiological the changes in chest compliance with
responses to exercise. Both, the resting and variation in Body Mass Index (BMI).
exercising energy expenditure rates are Including females only will facilitate better
increased in obese subjects, indicating comparison of data and will eliminate
higher exertion levels to optimize their gender-based bias in the study. [13]
responses to demands at rest and exercise. Therefore, the aim and objectives of
Although measurement of lung this study were as follows-
volumes provides more accurate data
International Journal of Health Sciences and Research (www.ijhsr.org) 18
Vol.11; Issue: 7; July 2021Divya Sharma et.al. Correlation between body mass index (BMI) and chest expansion values in young adult
females: a cross sectional study.
AIM: To find correlation between Body Index (BMI) was determined using WHO
Mass Index (BMI) and chest expansion classification. [14-15] Next, chest expansion
values in young adult females. was measured using tape method. [16]
Subject was in sitting position, with hands
OBJECTIVES: placed on the occiput. The measuring tape
1. To calculate the Body Mass Index was placed on the chest and the subject was
(BMI) of female young adult subjects instructed to exhale out completely. This
using height and weight measurements. reading was noted. Next, the subject was
2. To measure the chest expansion of asked to inhale deeply via nostrils.
subjects by tape method. Measurement was made at the same level in
3. To find the correlation between Body a position of full inspiration. The difference
Mass Index (BMI) and chest expansion between the two readings was noted and
values at the level of axilla. compared with normative data. [17]
4. To find the correlation between Body The above measurements were taken
Mass Index (BMI) and chest expansion at 3 levels-axilla (2nd intercostal space),
values at the level of the nipple. nipple (4th intercostal space) and
5. To find the correlation between Body xiphisternum. [15] Three readings were
Mass Index (BMI) and chest expansion recorded at each level and best of three
values at the level of xiphisternum. readings were considered. Body frame type
was noted. All necessary precautions were
METHODOLOGY taken during the assessment of subjects,
A Cross sectional correlation study given the backdrop of the Covid-19
was conducted over a period of 6 months pandemic. The data was compiled and
(December 2020 to June 2021) in healthy analyzed using the appropriate statistical
young adult females. Young adult non tests. This was followed by interpretation of
exercising females (18-24 years of age) data and arrival at a conclusion.
were considered for the study. Females with The sample size was calculated
coexisting respiratory disease, with using OpenEpi software. The level of
comorbidities (musculoskeletal, significance was taken as 5%, confidence
neurological, cardiac or endocrine) which level as 95% and power 90%. Expected
may affect respiratory function, who were correlation coefficient between Body Mass
pregnant or lactating, who were suffering Index (BMI) and chest expansion (at
from psychological disorders including axillary level) as per the parent article was
eating disorders, who had a history of taken as – 0.42. The minimum sample size
pathological weight loss in last 6 months, obtained was 55.
chronic smokers and those actively
participating in fitness programs were STATISTICAL ANALYSIS:
excluded from the study. Verbal Table 1: Distribution of the subjects across various Body Mass
advertisement was done. Subjects in the age Index (BMI) categories
group of 18-24 years were recruited from SR. CATEGORY OF Body Mass NUMBER OF
NO. Index (BMI) PARTICIPANTS
students, staff and clients coming to fitness 1. Underweight (Divya Sharma et.al. Correlation between body mass index (BMI) and chest expansion values in young adult
females: a cross sectional study.
sample size (N) was considered as 59. All The statistical analysis was done
the subjects were females, the mean age using GraphPad Instat software (version
being 21.83 years. Table no. 1 shows the 3.0). Table no.2 shows the mean, standard
distribution of subjects across various Body deviation and normality of the data
Mass Index (BMI) categories. obtained.
Table 2: Parameters obtained on Statistical analysis
Sr. Parameters Body Mass Index Chest expansion Chest expansion Chest expansion values at the
No. (BMI) (kg/m2) values at axilla (cm) values at nipple (cm) xiphisternum (cm)
1. Mean 24.11 4.56 5.44 5.47
2. Standard 4.719 1.016 1.223 0.9992
deviation (SD)
3. Normality test p 0.0348 >0.10 >0.10 0.0647
value
4. Passed normality No Yes Yes Yes
test
The scatter plots for correlation between Body Mass Index (BMI) and chest expansion
at each reference level were plotted subsequently and they are as follows-
Figure (1). Correlation between Body Mass Index (BMI) and chest expansion values at axilla
Figure 2. Correlation between Body Mass Index (BMI) and chest expansion values at the level of nipple
International Journal of Health Sciences and Research (www.ijhsr.org) 20
Vol.11; Issue: 7; July 2021Divya Sharma et.al. Correlation between body mass index (BMI) and chest expansion values in young adult
females: a cross sectional study.
Figure 3. Correlation between Body Mass Index (BMI) and chest expansion values at the level of xiphisternum
The data passed Normality and The statistical parameters namely,
therefore, Pearson correlation coefficient Pearson correlation coefficient (r),
was used to analyse the correlation between coefficient of determination (r squared), and
Body Mass Index (BMI) and chest p value obtained for each of the reference
expansion at each reference level. levels are as follows- (Table no. 3)
Table 3. Statistical parameters for each reference level
Parameters At the level of axilla At the level of nipple At the level of xiphisternum
Pearson Correlation coefficient (r) -0.1856 -0.1605 -0.1453
Coefficient of determination (r squared) 0.03446 0.02557 0.02113
p value 0.1592 0.2245 0.2720
Statistical significance Not significant Not significant Not significant
RESULT with Body Mass Index (BMI). The results of
Table no. 3 shows that for each this study imply that a true linear
reference level, a large p value has been relationship may not exist between Body
obtained (>0.05) at 95% confidence level. Mass Index (BMI) and chest expansion
This signifies that there is a weak negative values in the young adult age group.
correlation between Body Mass Index The body frame type, i.e. the
(BMI) and chest expansion values, and it is characteristic pattern of body fat distribution
not statistically significant. for an individual may affect the chest
expansion values. [18] An android body
DISCUSSION frame which comprises increased adipose
By means of this study, an attempt tissue in the thoracoabdominal regions
was made to understand the direct substantially increases the risk of non
correlation of Body Mass Index (BMI) with communicable diseases such as Type-2
chest expansion values in young adult Diabetes Mellitus, Hypertension, metabolic
females. Statistical analysis revealed a weak syndrome, etc [19]. Android obesity has
negative correlation between Body Mass therefore been likened to central obesity,
Index (BMI) and chest expansion values at and may affect chest wall mobility more
all three reference levels and it was than a gynoid body frame type, which
statistically not significant. This suggests signifies an increase in the adiposity in the
that a complex relationship exists between gluteal and pelvifemoral regions of the body
[18-19]
the two variables and that there may be Android obesity is said to be more
several other contributing factors that may prevalent in males and gynoid obesity, in
affect chest wall mobility in conjunction females. However, at a higher Body Mass
International Journal of Health Sciences and Research (www.ijhsr.org) 21
Vol.11; Issue: 7; July 2021Divya Sharma et.al. Correlation between body mass index (BMI) and chest expansion values in young adult
females: a cross sectional study.
Index (BMI), the body frames of both males confirms similar findings in obese patients
and females resemble those of central and suggests the need to incorporate
obesity. [18-19] respiratory muscle strengthening exercises
There is a wide physiological in training programs for obese patients.[23-24]
variation amongst individuals in the Kevin Triangto et.al. conducted a
respiratory biomechanics owing to study on the biomechanical effects of
differences in the shape, size and orientation forward head posture on the respiratory
of the costovertebral, chondrosternal and function. They reported that a prolonged
sternocostal articular surfaces. Larger and forward head posture affects the respiratory
more mobile articular surfaces at these mechanics [25]. Another study done by See
joints would mean a better excursion of the Yoon Kim et.al. confirms similar findings in
ribs during inspiration and expiration, young adults. [26] Smartphone usage time
overall contributing to better chest wall can be attributed to cause postural
mobility.[20] Along with individual skeletal dysfunction [20,22] and a study by Sang In
variations, several studies have also reported Jung et.al. confirms that prolonged hours of
individual variations in the proportion of smartphone use adversely affect both,
Type-1 and Type-2 muscle fibres in the posture as well as respiratory mechanics.[27]
respiratory muscles such as diaphragm, the This shows that there is a need to address
intercostals, and the accessory muscles of postural deviations in young adults in order
respiration, namely, scaleni, to improve respiratory function.
sternocleidomastoid, pectoralis major,
[21]
serratus anterior and so on. CONCLUSION
Like for every peripheral skeletal A weak negative correlation between
muscle, an optimum length-tension Body Mass Index (BMI) and chest
relationship must exist for muscles of expansion was noted and it was not
respiration, in order to work at their statistically significant.
maximum efficiency. A deviation from the The results of the study indicate that
optimal muscle length reduces its capacity a direct correlation between Body Mass
of maximum force production, thereby Index (BMI) and chest expansion values
affecting the work produced, in this case, may be difficult to establish, and that a
being the excursion of the ribs during complex, multifactorial relationship exists
inspiration and expiration.[20] between the two variables. Further research
Poor postural habits are a well- is needed in this domain to better
known cause of musculoskeletal understand the same.
[22]
dysfunction , with certain muscle groups Research concerning obesity and
showing a predilection for shortening other non-communicable diseases are ever-
(tightness) and the opposing muscle groups evolving. Therefore, it is of utmost
for weakness, due to lengthening.[22] A pre- importance that clinicians and researchers
existence of upper-crossed syndrome may stay abreast of the latest developments in
cause alterations in respiratory mechanics, this field, in order to formulate the best
thereby affecting the chest expansion. [20-22] practices and provide the best available
Respiratory muscle strength is an treatments and fitness programs to the
important aspect of respiratory mechanics, concerned patients. Evidence based clinical
especially in activities requiring heavy practice must be encouraged.
exertion and forced inspiration and At this juncture, the authors would
expiration.[23] A study done by Fernanda de like to state certain identified limitations and
Cordoba Lanza et.al. reports that there is a put forth certain suggestions which may
relationship between chest wall mobility, guide future research in this domain.
respiratory muscle strength and lung
volumes [24] Another study by Sarikaya et.al.
International Journal of Health Sciences and Research (www.ijhsr.org) 22
Vol.11; Issue: 7; July 2021Divya Sharma et.al. Correlation between body mass index (BMI) and chest expansion values in young adult
females: a cross sectional study.
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females: a cross sectional study.
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Determinants of the variability in Correlation between body mass index (BMI)
respiratory exchange ratio at rest and during and chest expansion values in young adult
exercise in trained athletes. Am J Physiol females: a cross sectional study. Int J Health Sci
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