Sex Differences in Upper- and Lower-Limb Muscle Strength in Children and Adolescents: A Meta-Analysis

On average, adult men are physically stronger than adult women. The magnitude of this difference depends on the muscle tested, with larger sex differences observed in upper- than lower-limb muscles. Whether body region-specific sex differences in strength exist in children is unclear. The purpose of the current meta-analysis was to determine whether sex differences in muscle strength in children and adolescents differ between upper- and lower-limb muscles. Data were extracted from studies of participants aged ≤ 17 years who completed tests of maximal isometric or isokinetic strength of upper-limb muscles (e.g., elbow flexors and elbow extensors) or lower-limb muscles (e.g., knee extensors and ankle dorsiflexors). Participants were partitioned into three age groups: 5-10 years old, 11-13 years old, and 14-17 years old. The analysis included 299 effects from 34 studies. The total sample was 6634 (3497 boys and 3137 girls). Effect sizes of sex differences in upper- and lower-limb strength were g = 0.65 (95% confidence intervals (CI) [0.46, 0.84]) and 0.34 (95% CI [0.19, 0.50]) in 5-10-year-olds; g = 0.73 (95% CI [0.56, 0.91]) and 0.43 (95% CI [0.27, 0.59]) in 11-13-year olds; and g = 1.84 (95% CI [1.64, 2.03]) and 1.18 (95% CI [1.00, 1.37]) in 14-17-year-olds. Upper- and lower-limb strength were 17% and 8% greater in boys than girls when 5-10 years old, 18% and 10% greater when 11-13 years old, and 50% and 30% greater when 14-17 years old. Thus, boys are stronger than girls on average. This sex difference exists before puberty, increases markedly with male puberty, and is more pronounced in upper- than lower-limb muscles throughout development.