ISME 2017 : The Second International Conference on Industrial, Systems and

Manufacturing Engineering, Oct 17, 2017

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A Psychophysical Approach for Predicting Hand Muscle Strength in Jordanian
Cancer Patients at King Hussein Cancer Foundation Centre

Dr. Hesham A. Almomani, Heshamalmomani@hu.edu.jo. Industrial Engineering Department, The Hashemite

University, Zarqa, 13133, Jordan

ABSTRACT

In the healthcare industry, cancer is considered one of the most dangerous and life-threatening diseases of our time.
Latest researches show that handgrip strength, whether we are considering the amount of force an individual can
apply, or the time endurance limit they can sustain is a significant factor that can influence an individuals
performance in general and cancer patients in specific. Handgrip strength is linked with cancer-related fatigue
(CRF), used as indication for subjective sense of tiredness and is synchronized with reduced physical function. This
research tries to determine handgrip strength for cancer patients through measuring the Maximum Voluntary
Contraction (MVC) and Isometric Endurance Limit (IEL) for hand muscles; which are both reliable tools for patient-
generated subjective global assessment. Assuming most cancer patients have experienced the same symptoms with
widely common clinical manifestation; this research experiment has chosen a sample of [49] Jordanian cancer
patients as its subjects, all undergoing treatment at King Hussein Cancer Center (KHCC), ages (20-66). A
psychophysical approach, based on human subjective perception of fatigue has been used, digital hand grip
dynamometer was employed to increase the accuracy of the experiment and investigate the effect of five different
factors: (Gender (M, F), Age (Y), Cancer Type, Height (H), and Body Mass Index (BMI)), and result in two values:
MVC, and IEL. The factors were tested on variant levels, as follows: Gender (2 Levels), Age (6 levels), cancer type
(10 levels), Height (3 levels), and BMI (3 levels). The IEL was tested for MVC at 20%, 40%. and 60%; which
reflect real-life situations. The experiment outputs (MVC, and IEL values) were analyzed using Statistical Analysis
methods, Mathematical Modeling and Neural Network Analysis, results were obtained in relation to the previously
mentioned factors, independently. As expected, researchers found that not all factors had a major effect, as some
only had correlation effects, especially those related to the subjects' physical abilities. For MVC part the experiment
found that cancer type has major effects on both MVC and IEL values, whereas Limited effect found for BMI, Height,
Age and Gender and this explained because of depraved psychological state of the patient and sample size for each
cancer type that might affect the experiment results. While results from this research verify other researchers' work,
they aim to establish a comprehensive model for Jordanian cancer patients, taking into consideration the
psychological state of the subjects as an error that might affect the experiments output. The researchers hope to
redo the experiment, testing more subjects, and including more types of cancer, considering the great number of
cancer types, and their causes.

Keywords: Jordanian Cancer Patients, Isometric Hand Muscle Strength, Maximum Voluntary Contraction,
Isometric Endurance Limit
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Introduction

Cancer, although generally not a transmissible disease, Tolar J et al. (2003) stated that it is one of the most life-
threatening diseases that affect humans, even if cured; the long, and tedious medication periods affect the patients
lifestyle and physiological state. Many researches show that environmental factors are responsible for around 95% of
cases, leaving only 5% due to inherited genetics Anand P et al. (2008), Kravchenko J, et al. (2009) States that economic,
behavioral, and lifestyle factors such as smoking, stress, lack of physical activity and obesity increase the probability
of cancer being terminal, other major cancer-causing factors are radiation, and pollution. Cancer types are specified on
oncology-related terms, as defined by Varricchio G et al. (2004) as the type of cell that the tumor cells resemble, and is
therefore presumed to be the origin of the tumor: Carcinoma (Most common type), Sarcoma (raised from connective
tissue), Germ-cell tumors (testicle or the ovary), Immature Precursor tumors, and Embryonic Tissue tumors. Other
categorization methods may be used depending on other factors. Considering the extended cancer treatment periods,
and the horrible side-effects the patients suffer, we can say that it drastically affects their lifestyle, and leaves them in
need of special management. A paper written by Redd WH et al. (2000) on 54 published studies from the past 20 years
has brought clinical attention to the need for more effective side-effect control. Unfortunately, one of the hardest cancer
treatment side-effects to recover from is muscle fatigue. Work-Related Musculoskeletal Disorders (WMSD), as defined
by Canadian Centre for Occupational Health and Safety, a group of painful disorders exhibited in body muscles,
tendons, and nerves, and are associated with discomfort, hurt and pain. Both WMSD and DMSD can be measured
through Muscle Fatigue Measurements (Isometric, and Isotonic Endurance Limits). Untreated DMSD will have a
serious effect on the muscle cells and tissues in the human body. The Handgrip Strength (HGS) tests may be used as an
indicator of overall muscle strength, Silvia M et al. (2011). To help represent HGS, we use MVC, which is defined by
Segen, (2002) as the maximum force achieved in one single voluntary effort or by Tufts University Nutrition
Collaborative Center as power grip force resulted of forceful flexion of all finger joints. According to Hesham, (2015),
a general rule is that people with strong hands tend to be strong elsewhere, therefor the MVC test is often used as a
general test of muscle strength. The objective of the research is to find and verify the major factors that affect static and
dynamic grip forces in exertion and obtain the measurements for: MVC, and IEL at (20%, 40% and 60%). Human body
fatigue is a periodic process and it can be recovered from, according to Rohmert, (1966), and Edwards, (1981). It is
defined as the failure to sustain force required to complete a task, muscle fatigue causes reduction in MVC, as Ana, T
et al. (2016), mentioned: HGS and Patient-generated Subjective Global Assessment are used to measure different
parameters, such as nutritional status and muscle strength. Human body fatigue is a general indication to the overall
health, and as Chih-Hao et al. (2011) states that it is useful to estimate patients corporeal status, he continues to explain
that diseases affect human muscle strength, especially ones attacking human bones. MVC and IEL researches show the
correlation between different diseases and muscle fatigue, where according to The American Academy of Neurology's,
(2014) it raises the risk of stroke in people over the age of 65, and is higher for Chronic kidney disease patients as
stated by The Gerontology Department, Ain Shams University, Cairo, (2013), it also affects the Nutritional status, and
bone mineral content according to Sirajudeen et al. (2012), Causes Dementia and affects walking as Sanderson et al.
(2014), and The American Academy of Neurology's, (2014) confirm. Silvia M et al. (2011) states that HGS is strongly
correlated with postoperative complications and the length of hospital stay., as Matos et al. (2007) mentioned that it is
also good predictor in evaluating the nutritional risk of cancer. As Silvia M et al. (2011) explains that cachexia seems
to be a predominant cause of decreased muscle strength in patients, as most cachectic patients lose muscle mass, and
strength. Muscle mass can be lost at 1% per month and strength at 2-4% per month in older advanced cancer patients,
per Edgar et al. (2012). Handgrip dynamometry, per Ana T et al. (2016) is used to evaluate skeletal muscle function,
it is a none costly measurement used to assess the functional capacity in patients, she explains that the it is noninvasive,
economic, portable, user friendly and sensitive to the short-term changes in the muscular function preceding disease-
related malnutrition. Hand dominancy, studied by Kilgour et al. (2010, 2013) shows that IL-6 levels were found to
strongly predict HGS in both hands for both genders. It predicted a variance of (3.2%) in right-sided HGS and of (2.7%)
in left-sided HGS. Granger, et al. (2013) defines Physical activity as any bodily movement produced by skeletal
muscles, and result in energy consumptions, and explains that non-small cell lung cancer (NSCLC) is associated with
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impaired physical status and diminished physical activity, mainly due to the diseases treatment, whether it was surgery,
chemotherapy, or radiotherapy. Varied physiological and psychological effects are prevalent in NSCLC, such as
exercise intolerance, weakness, and impaired gas exchange, and commonly a cycle of declined functionality ensues.
Kerri M. Et al. (2012) implies that cancer survivors can safely engage in resistance exercises to improve lower and
upper body strength, reducing the risk of falls, or future disability. Kerri M. et al. (2012) assures that it can reverse
muscle weakness, restore balance, and reduce falls and declined functionality in elders, even without cancer. strategies
to promote resistance training improve muscle strength greatly. Many researchers got the result that patients with
lymphedema have lower and upper extremity muscle strength and greater activity limitation than normal people, in fact,
it has been shown that resistance-strengthening exercises do not aggravate lymphedema, but cause additional swelling,
and significantly reduced proximal arm volume and improved quality of life, still. Other researchers, such as Daegu L
et al. (2015) have a different opinion, he fears this belief of physical exercise and activity limitation is spreading through
cancer community, and eventually lead to muscle atrophy, weakness, and worsened upper impairments. Many patients
failed to improve their strength and experienced activity limitations. Daegu L et al. (2015) evaluated different
independent factors that affect muscle strength, and upper extremity physical function in patients with lymphedema.
Factors that were evaluated include Lymphedema factors, patients symptoms, psychological factors, information
about restricting the affected arm, and behavioral factors. Cancer patients have symptoms associated with fatigue, such
as weight loss, in advanced staged cancer it is a common clinical indicator correlated with reduced physical function,
and a reduction in body performance, and quality of life. CRF is a good indication for the subjective sense of tiredness.
P. Cresta M et al. (2016) states that CRF has a wide variety of clinical aspects, which make its conceptualization
complex, it is a complex syndrome with predominance of mechanisms of central fatigue over peripheral fatigue, A.
Navigante et al. (2013) agrees to her statement, and defines it as a multidimensional syndrome that causes several
clinical aspects such as mood disorders, early satiety, pain dyspnea, insomnia, dry mouth, impairment, infection, and
anemia. Because of its complex nature, researchers on CRF field have coined the term Fatigue Word Descriptors (FWD)
to identify the clinical associations, not to be misunderstood with weakness, as they are not synonymous; however,
some patients such as women with breast cancer, who underwent adjuvant chemotherapy experience fatigue without
evidence of illness. Its worth mentioning that only 26 % of patients have ACS, but 90 % experience fatigue. In addition,
Robert D et al. (2010) mentioned several conditions, biomarkers, and medical issues correlated with fatigue, such as
associated anemia-hypoalbuminemia, high levels of pro-inflammatory cytokines, and tumor necrosis. The details of the
cachexia mechanism remain unknown, Evans, and Koichi T. et al. (2016) state the need to improve the quality of life
for patients, and to address the issues surrounding cachexia. ANCOLI et al. (2001) states that in general, the relationship
between cancer type and fatigue remains largely unknown. It is, of course, affected by psychosocial factors (clinical
depression, anxiety etc.), exacerbation symptoms (insomnia, chronic pain, and nausea), as well as treatment side-effects
(surgery, radiotherapy, and chemotherapy). Medication also has a major effect on muscle strength as Brian D., et al.
(2016) mentioned, some cancer medications like androgen deprivation therapy (ADT) decrease the HGS, Brian et al.
(2016) confirms that as he noticed changes in physical functioning and muscles strength in men receiving ADT for
prostate cancer. Height effect: Alex et al. (2013) stated that there is strong relationship between height and dominant
Maximum voluntary contraction (hand grip strength), For BMI effect: Montes (2001); Minnal (2014); Al Meanazel
(2013), Hesham, 2015, Montes (2001) and Stulen and De Luca (1981) mentioned that MVC have strong relation with
BMI, muscle diameter and also depends on muscle strength, some of above researchers mentioned that MVC depends
on brain-related factors. For Age effect: many researchers stated that no effect of age on isometric muscle strength
(Chatterjee and Chowdhury (1991) and Yassierli et al. (2003) found same result at certain fraction of 40% of MVC,
also mentioned is independent on gender in contrast with Bohannon et al. (2006) who stated that there is strong
relationship between MVC and both (gender and age).For isometric endurance limit, on Chatterjee and Chowdhuri
(1991) and Caldwell (1963) stated that there is no relationship between height effect and IE but there is strong
relationship between. BMI and IEL according to Crosby and Wehbe (1994), Hesham, (2015), Fraser et al. (1999),
Montes (2001), Sheriff et al., (2012), Al Meanazel (2013), and Minnal (2014).
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Research Methodology
The research experiment was done for [49] Jordanian Cancer patients at King Hussein Cancer Foundation (KHCC), all
of them participated in both Maximum Voluntary Contraction(MVC) and Isometric Endurance Limit (IEL) tests,
Subjects did not have any physical hand injuries. Anthropometric measurements have been collected, and descriptive
statistics can be summarized as follows: Age (20-62years), Weight (54-90Kg), Height (146-191cm), and BMI (19.133-
34.716) for Males. Age (22-66years), Weight (56-90Kg), Height (147-181cm), and BMI (21.3-41.65) for Females. The
dependent variables are: (MVC, IEL at [20%, 40%, 60%] of maximum MVC), and the independent variables are: Age
(6 levels), Cancer Type (10 levels), BMI (3 levels), Height (3 levels), Gender (2 Levels) as shown in Table 1-1 below:
Table 1-1 Dependent and Independent Variables with their Levels
Dependent Variables Independent Treatment Levels
Variables
1- MVC Age (years) 1) A0: (20 25), A1: (25-30), A2: (30-35), A3: (35-40), A4: (40-45), A5: (> 45)
2- Isometric
Endurance Cancer type 1) Colorectal Cancer(CC), Liver cancer(LC), Prostate gland(PG), Lymphoma(L),
Limit (20%, Thyroid Cancer(TC), Leukemia(LY), Non-small cell lung cancer(NSCLC),
40%, 60%) Body Mass Head
Small: andneck
S (19 25), cancer(HANC), 30), cancer(BC),
Medium: M (25breast bone cancer(BNC)
Large: L (> 30)
Index (BMI)
Height Short: S (<= 170), Medium: M (170 181), Tall: T (> 181)
Gender Male , Female

Fixed tape was used to measure heights in (cm) and the Handgrip Circumference, a digital stopwatch was used to
Measuring
Factors
record the Endurance Limit (to the nearest .01sec) and a digital scale to measure weights in (kg). The objective of the
research is to find and verify the major factors that affect static and dynamic grip forces in exertion and obtain the
measurements for: MVC, and IEL at (20%, 40% and 60%). Subjects participate in the experiment at different times and
1- Jordanian
under theSubjects
same conditions. The overall research methodology and procedure to conduct MVC and IEL test is shown in
Table (1-2) attached with this document.
Table 1-2 Overall Research Methodology for cancer patients
2- Digital
Dynamometer Start
Participants
49 cancer patients (Males and Females )
Gather Anthropometric Data (Independent Variables)
1. Age , 2. Weight, 3. Height , 4- Cancer Type, 5- Calculated BMI , 6- Gender
Maximum Grip Strength Test
1. Sitting with 180 degree hand to elbow
2. Hand grip Dynamometer adjusted to fit the GC
3. Each subject to exert maximum force on the Dynamometer
4. Do three Maximum Grip strength tests (for MVC)
5. for 5 seconds , and 5-minute rest
Isometric Test
1. Record subjects height and weight by using a digital scale and a measuring tape.
2. Each subject was asked to sit and volunteers were asked to make sure that their joints (hip, knees, and elbows) are at 180
degree .
3. Subject was asked to hold the hand grip dynamometer with one hand at a time at each designed percentage (20%, 40%
and 60% and was asked keep holding each partial MVC until pain and feeling of fatigue starts in their arm.
4. Record the time in seconds to fatigue for each partial MVC.
5. Give subject a 5-minute break

The analysis included an Analysis of Variance (ANOVA), using Minitab 17, followed by the use of different modeling
techniques to build models to predict MVC, IEL also using Minitab 17. The detailed Analysis is attached in document,
as Table 1-3. Below:
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Table 1-3 Data Analysis and Modeling Methodology
MVC data Isometric Muscle Fatigue (Endurance Limit Data)
Descriptive statistics (Model Adequacy Checks
Perform ANOVA
for dependent variables (MVC, Endurance limit and no. of cycles to fatigue)
Develop Linear Regression (LR) Models
Develop Non-Linear Regression (NLR) Models
Develop Neural Network Model

RESULTS AND DISCUSSION

The experiments were performed on 49 subjects (20 to 66 years old), The data was presented, analyzed and discussed
in this chapter. the dependent variables are as follows:

Maximum voluntary contraction (MVC) test: MVC (in Kg).

Experiment results were analyzed in the following manner. First, descriptive statistics were provided. Then, correlation
analysis, normality test, and outlier analysis were conducted. Since several dependent variables were considered in this
study, ANOVA, using Minitab 17. In addition, linear and non-linear regression models were developed and compared,
linear and non-linear regression models were developed and compared in addition to development Neural Network
Model.
For maximum voluntary contraction analysis and discussion, the descriptive statistics were provided above, full
factorial design of experiment for the following factors, level and values, (Age, 6 Levels, (A0, A1,A2, A3, A4, A5),
(Height, 3 Levels,(S, M,T), (BMI, 3 Levels, (S, M,L) and (Cancer type,10 Levels,(BC, BNC, CC, HANC, L, LC, LY,
NSCLC, PG, TC), tables 1-4 and 1-5 shows the ANOVA results for males and females, Model adequacy checks were
tested for MVC data and found that assumptions are met for constant variance normality and independency, ANOVA
with 85% confidence level was used to test the effects of the independent factors considered the overall situation of
cancer patients status. Hypothesis is presented as none of the experiment independent variables have any effect on the
output dependent variable, residual plots consist of normal probability plot, uniform distribution vs fits, uniform
distribution vs order, and normal histogram shape distribution are developed and residual plots support normality
assumption, table 1- 4 below show ANOVA results

Table 1- 4 Analysis of Variance for General Factorial Design Males and Females
Source DF Adj SS Adj MS F-value P-value DF Adj SS Adj MS F-value P-value
(M) (F) (F) (F) (F) (F)
Model 15 357.27 23.818 1.88 0.122 15 149.216 10.658 1.04 0.539
Linear 15 357.27 23.818 1.88 0.122 15 149.216 10.658 1.04 0.539
Age(cat) 5 60.33 12.066 0.95 0.477 5 38.823 7.765 0.76 0.621
Height(cat) 2 10.71 5.356 0.42 0.663 1 3.199 3.199 0.31 0.605
BMI(cat) 2 19.56 9.778 0.77 0.480 2 7.66 3.830 0.38 0.709
Cancer Type (cat) 6 234.22 39.036 3.09 0.038 6 96.728 16.121 1.58 0.0343
Error 14 176.97 12.641 4 40.814 10.203
Total 29 20
Major significant factor found is the cancer type, were the Limited non-significant factors are BMI, Height, Age and
Gender, this design concern R-sq = 78.25% For Males , and for females with R-sq = 80.75%, the patients bad
psychological state might affect the experiment results. to get rid of multicollinearity issue, all significant factors are
considered. MVC linear and non-linear regression equations were extracted using Minitab -17
Linear Model (Female), MAX MVC = 43.2 - 0.1136 Age - 0.048 Height - 0.179 BMI, ....(1)
Linear Model (Male), MAX MVC = 1.3 - 0.0872 Age + 0.0946 Height 0.478 BMI.....(2)
Non Linear Models, Males ) MAX MVC = Age * Height / (-21.2207 + 8.64093 * Age + 0.00951782 * Age * Height
- 0.122441 * Age * BMI) ......(3)
Non Linear Models, Female) MAX MVC = Age * Height / (-20.3595 - 4.17447 * Age + 0.0573285 * Age * Height
+ 0.0619121 * Age * BMI) .......(4)
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For age effect results, there was a limited number of studies that covered the age groups of 20-25 and 40-50 years
old. Most researchers do not agree on the most significant age group, possibly as a result of different experimental
conditions. This dissertation includes age groups with 5-year age intervals, experiment result shows that for males,
Highest MVC Value was for A1(25-<30): 32.8 kg, and Lowest MVC Value (Kg) for A5 (Above 45): 18.9 kg and
for females Highest MVC Value was for A2 (20-<25): 31.4 kg, and Lowest MVC Value (Kg) for A5(Above 45):
20.1kg, Table 1- 5 linear equations for Max MVC with age effect.
Table 1- 5 linear equations for Max MVC with age effect (Males & Females)
Males Females
A0 MVC = 3.2 - 0.295 Age + 0.0998 Height + 0.505 BMI MVC = 50.7 - 0.340 Age - 0.075 Height - 0.278 BMI
A1 MVC = 5.6 - 0.295 Age + 0.0998 Height + 0.505 BMI MVC = 59.5 - 0.340 Age - 0.075 Height - 0.278 BMI
A2 MVC = 4.5 - 0.295 Age + 0.0998 Height + 0.505 BMI MVC = 56.3 - 0.340 Age - 0.075 Height - 0.278 BMI
A3 MVC = 9.3 - 0.295 Age + 0.0998 Height + 0.505 BMI MVC = 57.5 - 0.340 Age - 0.075 Height - 0.278 BMI
A4 MVC = 6.8 - 0.295 Age + 0.0998 Height + 0.505 BMI MVC = 61.0 - 0.340 Age - 0.075 Height - 0.278 BMI
A5 MVC = 11.2 - 0.295 Age + 0.0998 Height + 0.505 BMI MVC = 61.8 - 0.340 Age - 0.075 Height - 0.278 BMI

Height effect research found that height has a major effect on MVC where taller people exerted more MVC with
additional 9.1% than medium, and 12.21% than short subjects. The Height Effect on MVC found the following, MVC
(Kg, male) T (27.3), M (25.66), S(25.26) and MVC (Kg, female) T (27.327), M (24.83), S (25.294), Table s1- 6
through 1-7 show the general linear equations for MVC with different independent factors and effect for males and
females)

Table 1- 6 The general linear equations for MVC with height effect for males and females)
Males Females
M MVC = -42.2 - 0.0771 Age + 0.307 Height + 0.676 BMI MVC = 109.8 - 0.208 Age - 0.364 Height - 0.415 BMI
S MVC =-37.8 - 0.0771 Age + 0.307 Height + 0.676 BMI MVC = 103.3 - 0.208 Age - 0.364 Height - 0.415 BMI
T MVC = -42.7 - 0.0771 Age + 0.307 Height + 0.676 BMI There was no tall females found in the sample

BMI effect research shows that greater MVC is exerted by subjects with medium BMI, The BMI Effect on MVC
found the following MVC (Kg, male) L(24.33), M( 26.57), S(24.81) and MVC (Kg, female) L( 24.56), M (25.53), S
(25.39)

Table 1-7 The general linear equations for MVC with BMI effect for males and females
Males Females
L MVC = -5.4 - 0.0920 Age + 0.1151 Height MVC =42.2 - 0.1295 Age - 0.091 Height + 0.027 BMI
+ 0.611 BMI
M MVC =-6.4 - 0.0920 Age + 0.1151 Height MVC = 46.3 - 0.1295 Age - 0.091 Height
+ 0.611 BMI + 0.027 BMI
S MVC = -4.7 - 0.0920 Age + 0.1151 Height MVC =46.3 - 0.1295 Age - 0.091 Height
+ 0.611 BMI + 0.027 BMI

Cancer Type Effect researches shows that the most type of cancer affect human body efficiency but the most likely
worst of them is bone cancer and Non-small cell lung cancer , figure 1-2 show the relation between cancer types and
MVC , the Cancer Type Effect on MVC found the following the following:
MVC Male (Kg) : BNC(20.2),CC (27.82),HANC(25.73),L(20.4),LC(26.15),NSCLC(21.05),PG(28.94)
MVC Female (Kg): BC(24.04),CC(24.34),HANC(20.1),LC(24.7),LY(22.1),NSCLC(21.55)
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Table 1- 8 The general linear equations for MVC with Cancer type effect for males and females:
Males Females
BNC MVC = 6.4 - 0.0305 Age + 0.0614 Height + 0.206 BMI MVC =42.2 - 0.1295 Age - 0.091 Height + 0.027 BMI
CC MVC =13.2 - 0.0305 Age + 0.0614 Height + 0.206 BMI MVC = 4.3 + 0.0069 Age + 0.0900 Height
+ 0.187 BMI.
HANC MVC = 11.1 - 0.0305 Age + 0.0614 Height + 0.206 BMI MVC = -0.3 + 0.0069 Age + 0.0900 Height
+ 0.187 BMI
L MVC = 6.8 - 0.0305 Age + 0.0614 Height + 0.206 BMI
LC MVC = 11.3 - 0.0305 Age + 0.0614 Height + 0.206 BMI MVC = 12.5 + 0.0069 Age + 0.0900 Height
+ 0.187 BMI.
NSCLC MVC = 7.0 - 0.0305 Age + 0.0614 Height + 0.206 BMI MVC = 1.2 + 0.0069 Age + 0.0900 Height
+ 0.187 BMI
PG MVC = 14.0 - 0.0305 Age + 0.0614 Height + 0.206 BMI -----------------------------------
BC ----------------------------------------------------- MVC = 6.6 + 0.0069 Age + 0.0900 Height
+ 0.187 BMI
LY ------------------------------------------------------ MVC = 2.9 + 0.0069 Age + 0.0900 Height
+ 0.187 BMI
TC ----------------------------------------------------------- MVC = 6.2 + 0.0069 Age + 0.0900 Height
+ 0.187 BMI

Isometric Endurance Limit: Analysis and Discussion

ANOVA results are presented in this section, in addition to the predicted general linear and nonlinear models for
isometric endurance limit. As mentioned before, the experiment is a human social experiment. Many studies found
the above non-significant factors to be significant. Linear regression equations were derived for all independent
factors, table 1-9 below shows the summary significant Factors Found with ANOVA
Table 1-9 Isometric Endurance Limit Significant Factors Found with ANOVA
Isometric Endurance Limit Significant Factors Non-significant Factors
Isometric En 20% , Males ---------- Cancer type, Age, height, BMI
Isometric En 20% , Females Cancer type Age, height, BMI
Isometric En 40% , Males ----------- Cancer type, Age, height, BMI
Isometric En 40% , Females Cancer type Age, height, BMI
Isometric En 60% , Males ------------- Cancer type, Age ,height. BMI
Isometric En 60% , Females Cancer type Age, height, BMI

Table 1- 10 Isometric Endurance Limit General Linear Regression Models for different percentages for (M&F)
LRM( Males) LRM( Females)
IL 20% = 42.5 + 0.0105 Age IL 20%=30.0 + 0.0168 Age + 0.042 Height
Isometric En 20% ,
+ 0.0050 Height - 0.009 BMI + 0.102 BMI
IL 40% = 32.5 + 0.0087 Age IL 40% = 22.1 + 0.0140 Age + 0.0348 Height
Isometric En 40% ,
+ 0.0042 Height - 0.007 BMI + 0.085 BMI
IL 60% = 34.8 + 0.0047 Age - 0.0303 Height IL 60% = 8.6 + 0.0197 Age + 0.0677 Height
Isometric En 60%
- 0.072 BMI + 0.172 BMI

Table 1-11 Isometric Endurance Limit General Non- Linear Regression Models different percentages for (M, F):
LRM( Males)
IL 20% = Age * Height / (4.51647 - 0.21509
Isometric En 20% , * Age + 0.0230003 * Age * Height +
0.00306499 * Age * BMI)
IL 40% = Age * Height / (6.39052 -
Isometric En 40% , 0.310519 * Age + 0.0300434 * Age * Height
+ 0.00440188 * Age * BMI
IL 60% = Age * Height / (7.89061 - 2.10743
Isometric En 60% * Age + 0.0435386 * Age * Height +
0.0217265 * Age * BMI)
LRM( Females)
IL 20%= Age * Height / (2.62791 + 1.00398 * Age +
0.0200029 * Age * Height - 0.0104855 *Age * BMI)
IL 40% = Age * Height / (3.74912 + 1.44028 * Age +
0.0257149 * Age * Height - 0.0150657 *Age * BMI)
IL 60% = Age * Height / (-50.1536 + 93.0979 * Age -
0.224782 * Age * Height - 1.5869 * Age *BMI)
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Age Effect on Isometric Endurance Limit found the following:

Isometric Endurance Limit (20%),in Kg
A0: (20-<25) (38.78 Female ,42.02 Male),A1: (25- <30),(42.38 Female ,43.6 Male ),A2: (30-<35),(40.22 Female ,
43.22 Male),A3: (35-<40)(39.54 Female ,45.4 Male )
A4: (40-<45)(42.44 Female ,43.67 Male),A5 (above 45)(39.847 Female ,43.15 Male )
Isometric Endurance Limit (40%)
A0: (20-<25) (29.4 Female , 32.1 Male),A1: (25- <30)( 32.4 Female ,33.41 Male), A2: (30-<35)(,(30.6 Female ,33.1
Male),A3: (35-<40),(30.03 Female,43.92 Male), A4: (40-<45)(32.45 Female ,33.47 Male),A5 (above 45)(30.29
Female,33.044 Male )
Isometric Endurance Limit (60%)
A0: (20-<25) (24.2 Female ,26.9 Male),A1: (25- <30),(27.9 Female ,27.8 Male ),A2: (30-<35),(25.33 Female , 28
Male),A3: (35-<40)(23.87 Female ,30.02 ) , A4: (40-<45)(25.5 Female , 27.7 Male),A5 (above 45)(24.567 Female
,27.622 )

The mean isometric endurance limit decreases as the fraction of the MVC increases (20%: 42.229 Seconds, 40%:
32.457 Seconds, 60%: 27.073 Seconds,), two age groups (A3 (35-<40) and A1 (35-<40)) exerted the highest isometric
mean endurance limit (35.393 and 34.5), followed by older ages

Table1- 12 The general linear equations for isometric endurance limit with age effect for Males and Females follows:
Isometric limit (Males)
Regression A0 Isometric limit 20% = 39.6 + 0.167 Age
Equation - 0.0044 Height - 0.020 BMI
(20%) A1 Isometric limit 20% = 40.2 + 0.167 Age
- 0.0044 Height - 0.020 BMI
A2 Isometric limit 20% = 39.2 + 0.167 Age
- 0.0044 Height - 0.020 BMI
A3 Isometric limit 20% = 40.6 + 0.167 Age
- 0.0044 Height - 0.020 BMI
A4 Isometric limit 20% = 37.9 + 0.167 Age
- 0.0044 Height - 0.020 BMI
A5 Isometric limit 20% = 35.3 + 0.167 Age
- 0.0044 Height - 0.020 BMI
Regression A0 Isometric limit 40% = 30.1 + 0.140 Age
Equation - 0.0037 Height - 0.017 BMI
(40%) A1 Isometric limit 40% = 30.6 + 0.140 Age
- 0.0037 Height - 0.017 BMI(67)
A2 Isometric limit 40% = 29.8 + 0.140 Age
- 0.0037 Height - 0.017 BMI
A3 Isometric limit 40% = 30.9 + 0.140 Age
- 0.0037 Height - 0.017 BMI
A4 Isometric limit 40% = 28.6 + 0.140 Age
- 0.0037 Height - 0.017 BMI
A5 Isometric limit 40% = 26.5 + 0.140 Age
- 0.0037 Height - 0.017 BMI
Regression A0 Isometric limit 60% = 32.5 + 0.109 Age
Equation - 0.0355 Height - 0.077 BMI
(60%) Males A1 Isometric limit 60% = 32.8 + 0.109 Age
- 0.0355 Height - 0.077 BMI
A2 Isometric limit 60% = 32.4 + 0.109 Age
- 0.0355 Height - 0.077 BMI
A3 Isometric limit 60% = 34.1 + 0.109 Age
- 0.0355 Height - 0.077 BMI
A4 Isometric limit 60% = 31.3 + 0.109 Age
- 0.0355 Height - 0.077 BMI
A5 Isometric limit 60% = 29.7 + 0.109 Age
- 0.0355 Height - 0.077 BMI
Isometric limit (Females)
A0 Isometric limit 20% = 29.1 + 0.184 Age
- 0.002 Height + 0.193 BMI
A1 Isometric limit 20% = 31.6 + 0.184 Age
- 0.002 Height + 0.193 BMI
A2 Isometric limit 20% = 30.1 + 0.184 Age
- 0.002 Height + 0.193 BMI
A3 Isometric limit 20% = 28.8 + 0.184 Age
- 0.002 Height + 0.193 BMI
A4 Isometric limit 20% = 31.1 + 0.184 Age
- 0.002 Height + 0.193 BMI
A5 Isometric limit 20% = 25.5 + 0.184 Age
- 0.002 Height + 0.193 BMI
A0 Isometric limit 40% = 21.3 + 0.154 Age
- 0.001 Height + 0.161 BMI(72)
A1 Isometric limit 40% = 23.4 + 0.154 Age
- 0.001 Height + 0.161 BMI
A2 Isometric limit 40% = 22.1 + 0.154 Age
- 0.001 Height + 0.161 BMI
A3 Isometric limit 40% = 21.1 + 0.154 Age
- 0.001 Height + 0.161 BMI
A4 Isometric limit 40% = 23.0 + 0.154 Age
- 0.001 Height + 0.161 BMI
A5 Isometric limit 40% = 18.4 + 0.154 Age
- 0.001 Height + 0.161 BMI
A0 Isometric limit 60% = 10.6 + 0.203 Age
+ 0.015 Height + 0.224 BMI
A1 Isometric limit 60% = 12.8 + 0.203 Age
+ 0.015 Height + 0.224 BMI
A2 Isometric limit 60% = 11.1 + 0.203 Age
+ 0.015 Height + 0.224 BMI
A3 Isometric limit 60% = 9.1 + 0.203 Age
+ 0.015 Height + 0.224 BMI
A4 Isometric limit 60% = 10.0 + 0.203 Age
+ 0.015 Height + 0.224 BMI
A5 Isometric limit 60% = 6.1 + 0.203 Age
+ 0.015 Height + 0.224 BMI
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The effect of height on isometric endurance limit found in this experiment insignificant. However, subjects with
medium to small height achieve higher endurance limits, especially in isometric endurance limit (20%) condition for
males. For other conditions, subjects with medium to tall height achieve higher endurance limits, they almost have the
same effect. Height effect on Isometric Endurance limit found the following
Isometric Endurance Limit (20%) , Males, Medium(44.15) , Small(42.39) ,Tall(43.82),
Isometric Endurance Limit (20%) , Females, Medium(41.52) , Small( 39.74)
Isometric Endurance Limit (40%) , Males, Medium(33.88),Small(32.862),Tall(33.6)
Isometric Endurance Limit (40%) , Fe males, Medium(31.68) , Small(30.2)
Isometric Endurance Limit (60%) , Males, Medium(28.071),Small(27.13),Tall(28.13)
Isometric Endurance Limit (60%) , Females, Medium(26.22), Small(24.529)

Table 1- The general linear equations for isometric endurance limit with height effect for males and Females
Isometric limit (Males) Isometric limit (Females)
Regression M, Isometric limit 20% = 110.9 - 0.0188 Age M, Isometric limit 20% = 97.8
Equation (20%) - 0.327 Height - 0.331 BMI - 0.0797 Age - 0.280 Height
males S, Isometric limit 20% = 104.9 - 0.0188 Age - 0.138 BMI(93)
- 0.327 Height - 0.331 BMI
T, Isometric limit 20% = 113.9 - 0.0188 Age S, Isometric limit 20% = 91.2 - 0.0797 Age
- 0.327 Height - 0.331 BMI) - 0.280 Height - 0.138 BMI(94)

Regression M, Isometric limit 40% = 89.5 - 0.0156 Age M, Isometric limit 40% = 78.6 - 0.0664 Age
Equation (40%) - 0.273 Height - 0.276 BMI - 0.234 Height - 0.115 BMI
males S Isometric limit 40% = 84.5 - 0.0156 Age
- 0.273 Height - 0.276 BMI S Isometric limit 40% = 73.1
T Isometric limit 40% = 92.0 - 0.0156 Age - 0.0664 Age - 0.234 Height - 0.115 BMI
- 0.273 Height - 0.276 BMI
Regression M Isometric limit 60% = 79.8 - 0.0188 Age M, Isometric limit 60% = 49.2
Equation (60%) - 0.248 Height - 0.288 BMI - 0.0381 Age - 0.125 Height + 0.028 BMI
males S Isometric limit 60% = 76.1 - 0.0188 Age S, Isometric limit 60% = 45.2 - 0.0381 Age
- 0.248 Height - 0.288 BMI - 0.125 Height + 0.028 BMI
T, Isometric limit 60% = 82.4 - 0.0188 Age
- 0.248 Height - 0.288 BMI

The effect of BMI on isometric endurance limit is insignificant also in this experiment. Isometric endurance limits of
males subjects with small and large BMIs are greater than those by subjects with Medium BMIs by 5.32% (overall
average), females subjects with small and medium BMIs are greater than those by subjects with large BMIs by 16.03%
(overall average) . Medium BMIs are associated with weakest readings in three isometric endurance limit test
conditions (20%, 40% and 60% The condition of 20% results in more endurance than others. BMI Effect on Isometric
Endurance Limit found the following:
Isometric Endurance Limit (20%) : Males :Large (44.33),Medium (42.7),Small (43.69)
Isometric Endurance Limit (20%) : Females , Large (39.29),Medium (41.75),Small (39.98)
Isometric Endurance Limit (40%) : Males, Large (34.03Medium (32.67), Small (33.719)
Isometric Endurance Limit (40%) : Females, Large (29.825),Medium (31.875), Small (30.4)
Isometric Endurance Limit (60%) : Males, Large (28.55Medium (27.31), Small (28.344)
Isometric Endurance Limit (60%) : Females Large (24.425),Medium (26.925), Small (24.464)

Table 1- The general linear equations for isometric endurance limit with BMI effect(males and Females) :
Isometric endurance limit males Isometric Endurance Limit Females
Regression Equation L Isometric limit 20% = 37.3 L Isometric limit 20% = 26.7 - 0.0010 Age
(20%) + 0.0070 Age + 0.0307 Height + 0.062 BMI - 0.011 Height + 0.418 BMI
M Isometric limit 20% = 35.5 M Isometric limit 20% = 31.7 - 0.0010 Age
+ 0.0070 Age + 0.0307 Height + 0.062 BMI - 0.011 Height + 0.418 BMI
S Isometric limit 20% = 37.0 S Isometric limit 20% = 32.5 - 0.0010 Age
+ 0.0070 Age + 0.0307 Height + 0.062 BMI - 0.011 Height + 0.418 BMI
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Regression Equation L Isometric limit 40% = 28.1 + 0.0059 Age L Isometric limit 40% = 19.3 - 0.0009 Age
(40%) + 0.0256 Height + 0.051 BMI - 0.0094 Height + 0.348 BMI
M Isometric limit 40% = 26.7 M Isometric limit 40% = 23.5 - 0.0009 Age
+ 0.0059 Age + 0.0256 Height + 0.051 BMI - 0.0094 Height + 0.348 BMI
S Isometric limit 40% = 27.9 S Isometric limit 40% = 24.2 - 0.0009 Age
+ 0.0059 Age + 0.0256 Height + 0.051 BMI - 0.0094 Height + 0.348 BMI)
Regression Equation L Isometric limit 60% = 32.0 L Isometric limit 60% = 7.6 + 0.0020 Age
(60%) + 0.0030 Age - 0.0135 Height - 0.047 BMI + 0.0199 Height + 0.399 BMI
M Isometric limit 60% = 30.8 M Isometric limit 60% = 12.1 + 0.0020 Age
+ 0.0030 Age - 0.0135 Height - 0.047 BMI + 0.0199 Height + 0.399 BMI
S Isometric limit 60% = 31.6 S Isometric limit 60% = 12.1 + 0.0020 Age
+ 0.0030 Age - 0.0135 Height - 0.047 BMI + 0.0199 Height + 0.399 BMI

Cancer type effect results show that male subjects with Prostate gland and Lymphoma have greater endurance limits
, were the male subject with bone cancer and non-small cell lung cancer have the lowest endurance limits , females
subjects with Thyroid Cancer and colorectal cancer have the highest endurance limit and female subjects with liver
cancer and Leukemia have the lowest endurance limit .
Cancer Type Effect on Isometric Endurance Limit found the following values
Isometric Endurance Limit (20%),
BC(40.94), BNC(38.9),CC(42.85),HANC(39.98),L(45.98),LC(41.72),LY(36.5),NSCLC(40.88),PG(45.51),TC(46.9)
Isometric Endurance Limit (40%), BC(31.2),
BNC(29.5),CC(32.79),HANC(30.4),L(35.4),LC(31.85),LY(27.5),NSCLC(31.15),PG(35.01),TC(36.2)
Isometric Endurance Limit (60%)
BC(25.9),BNC(24.15),CC(27.86),HANC(25.48),L(29.7),LC(26.18),LY(21.4),NSCLC(25.38),PG(29.445),TC(28.9)

Table 1- The regression equations for Cancer Type Effect on Isometric Endurance Limit (males and Females)
Males Females
Regression BNC Isometric limit 20% = 30.6 + 0.0731 Age --------------------------------------------------
Equation + 0.0424 Height - 0.112 BMI
(20%) CC Isometric limit 20% = 36.3 + 0.0731 Age Isometric limit 20% = 57.8 - 0.0342 Age
+ 0.0424 Height - 0.112 BMI - 0.0603 Height - 0.166 BMI
HANC Isometric limit 20% = 34.0 + 0.0731 Age Isometric limit 20% = 53.7 - 0.0342 Age
+ 0.0424 Height - 0.112 BMI - 0.0603 Height - 0.166 BMI
L Isometric limit 20% = 39.1 + 0.0731 Age --------------------------------------------------
+ 0.0424 Height - 0.112 BMI
LC Isometric limit 20% = 35.2 + 0.0731 Age Isometric limit 20% = 52.5 - 0.0342 Age
+ 0.0424 Height - 0.112 BMI - 0.0603 Height - 0.166 BMI
NSCLC Isometric limit 20% = 34.2 + 0.0731 Age Isometric limit 20% = 54.7 - 0.0342 Age
+ 0.0424 Height - 0.112 BMI - 0.0603 Height - 0.166 BMI
PG Isometric limit 20% = 38.8 + 0.0731 Age --------------------------------------------------
+ 0.0424 Height - 0.112 BMI
BC -------------------------------------------------- Isometric limit 20% = 56.9 - 0.0342 Age
- 0.0603 Height - 0.166 BMI
LY -------------------------------------------------- Isometric limit 20% = 51.4 - 0.0342 Age
- 0.0603 Height - 0.166 BMI
TC -------------------------------------------------- Isometric limit 20% = 62.8 - 0.0342 Age
- 0.0603 Height - 0.166 BMI
Regression BNC Isometric limit 40% = 22.6 + 0.0609 Age --------------------------------------------------
Equation + 0.0353 Height - 0.093 BMI
(40%) CC Isometric limit 40% = 27.4 + 0.0609 Age Isometric limit 40% = 45.3 - 0.0285 Age - 0.0503 Height
+ 0.0353 Height - 0.093 BMI - 0.139 BMI
HANC Isometric limit 40% = 25.4 + 0.0609 Age Isometric limit 40% = 41.8 - 0.0285 Age - 0.0503 Height
+ 0.0353 Height - 0.093 BMI - 0.139 BMI
L Isometric limit 40% = 29.7 + 0.0609 Age
+ 0.0353 Height - 0.093 BMI
LC Isometric limit 40% = 26.4 + 0.0609 Age Isometric limit 40% = 40.9 - 0.0285 Age - 0.0503 Height
+ 0.0353 Height - 0.093 BMI - 0.139 BMI
NSCLC Isometric limit 40% = 25.6 + 0.0609 Age Isometric limit 40% = 42.7 - 0.0285 Age - 0.0503 Height
+ 0.0353 Height - 0.093 BMI - 0.139 BMI
PG Isometric limit 40% = 29.4 + 0.0609 Age
+ 0.0353 Height - 0.093 BMI
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BC ------------------------------------------------- Isometric limit 40% = 44.5 - 0.0285 Age - 0.0503 Height
- 0.139 BMI
-
LY ------------------------------------------------- Isometric limit 40% = 39.9 - 0.0285 Age - 0.0503 Height
- 0.139 BMI
-
TC ------------------------------------------------- Isometric limit 40% = 49.4 - 0.0285 Age - 0.0503 Height
- 0.139 BMI
-
Regression BNC Isometric limit 60% = 27.6 + 0.0517 Age --------------------------------------------------
Equation - 0.0111 Height - 0.176 BMI
(60%) CC Isometric limit 60% = 32.9 + 0.0517 Age Isometric limit 60% = 34.3 - 0.0573 Age
- 0.0111 Height - 0.176 BMI - 0.0054 Height - 0.126 BMI
HANC Isometric limit 60% = 30.9 + 0.0517 Age Isometric limit 60% = 30.7 - 0.0573 Age
- 0.0111 Height - 0.176 BMI - 0.0054 Height - 0.126 BMI
L Isometric limit 60% = 33.8 + 0.0517 Age --------------------------------------------------
- 0.0111 Height - 0.176 BMI
LC Isometric limit 60% = 31.4 + 0.0517 Age Isometric limit 60% = 27.7 - 0.0573 Age
- 0.0111 Height - 0.176 BMI - 0.0054 Height - 0.126 BMI
NSCLC Isometric limit 60% = 30.6 + 0.0517 Age Isometric limit 60% = 30.3 - 0.0573 Age
- 0.0111 Height - 0.176 BMI - 0.0054 Height - 0.126 BMI
PG Isometric limit 60% = 34.1 + 0.0517 Age --------------------------------------------------
- 0.0111 Height - 0.176 BMI
BC ----------------------------------------------- Isometric limit 60% = 32.5 - 0.0573 Age
- 0.0054 Height - 0.126 BMI
LY ----------------------------------------------- Isometric limit 60% = 27.3 - 0.0573 Age
- 0.0054 Height - 0.126 BMI
TC ----------------------------------------------- Isometric limit 60% = 35.3 - 0.0573 Age
- 0.0054 Height - 0.126 BMI

Conclusion and Future Work

Experimental studies were conducted with a psychophysical approach to examine the effect of static/dynamic forces,
on the hand grip fatigue and strength, maximum voluntary contraction (MVC), fatigue limits, and endurance for
subjects in the cancer patients. In this comprehensive research, five independent factors were considered which are
most likely to represent all possible factors, including new apparatus (digital dynamometer), cancer type and wide
range of patients age (20 to 66 years old) subjects, the uniqueness and significance of the research was done on
Jordanian cancer patients and illustrated in reliance of hand grip strength as a biological sign in medical (especially
in cancer treatment), the results from this research add valuable information to researchers' work, it also proposes
comprehensive models considering five different factors. Results were analyzed by many statistical test, mathematical
modeling and machine learning techniques. General, detailed were developed to predict MVC, maximum isometric
endurance limit of submaximal (20%, 40% and 60%), The experimental results were presented in tow sections, first
focuses on maximum voluntary contraction (MVC) and second for isometric muscle fatigue limit for different MVC
ratios (20%, 40%and 60%). It is very important to consider all variables and conditions of experiments in comparing
different models since there is no standardized procedure for all experiments, in contrast to many studies in the
literature, this experiment considers all factors which might have a significant or limited effect, since its a human
social experiment, and non-significant factors found in this experiment were found significant in many other studies,
during the last periods, studies on MVC isometric endurance limits used different fractions of MVC, in this experiment
The fractions of 20%, 40%, and 60% of the MVC were examined, used for comparisons with latest studies during the
last five years. All independent factors had correlation effects as expected, since most of them are related to subjects'
physical factors (of the human body) such as height, weight, and body mass index. isometric endurance limit at 20%
of the MVC, Height and BMI. ANOVA was conducted with full factorial experimental design, ANOVA tests verify
cancer type as major significant factor, again we consider all factors since we know from literature that they are
significant beside considering the experiment environmental condition and the status of cancer patient, residual plots,
histogram of the residuals, residuals versus order of data normality assumption holds, main effects resulted that the
model fit in ANOVA, regardless it is forming a straight line with few points that depart from the straight line, the
general linear and nonlinear models for MVC Test and isometric endurance limit were shown in discussion for
significant factors. For The MVC part, the Age Effect on MVC concluded the following: Highest MVC Value was
for A1(25-<30): 32.8 kg, and Lowest MVC Value (Kg) for A5 (Above 45): 18.9 kg and for females Highest MVC
Value was for A2 (20-<25): 31.4 kg, and Lowest MVC Value (Kg) for A5(Above 45): 20.1kg, for height effect on
MVC concluded the following :( Height has a major effect on MVC, Taller people exerted more MVC than medium
(6.007%) and shorter (7.56%). For BMI Effect on MVC concluded the following: (BMI has a minor effect on MVC,
 ISME 2017 : The Second International Conference on Industrial, Systems and
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Medium BMI subjects exerted higher MVC than large BMI subjects (by 3.79%) and small BMI subjects (by 0.054
%) and Highest MVC exerted in MVC (Kg, male, large BMI). For cancer Type Effect on MVC concluded the
following:( Cancer type has a Major effect on MVC (NOT All types mostly exerted the same MVC), Highest MVC
exerted by Prostate gland patients for males and Liver Cancer for Females. And lowest MVC exerted by bone cancer
and lymphoma for males and leukemia and non-small cell lung cancer patients for females. For the Isometric
Endurance Limit part, the age effect on isometric endurance limit concluded that: (Highest isometric mean endurance
limit exerted in A3: (35-<40), followed by A4:(40-<45) for males, Highest isometric mean endurance limit exerted in
A1: (25-<30), followed by A4:(40-<45) for females, (Highest isometric mean endurance limit (43.96 Sec) and Lowest
endurance limit found in males for age A0(20-25), and for age A3(35-40). For the height effect on isometric endurance
limit concluded that (minor effect of height on isometric endurance limit, Subjects with tall height exerted higher
endurance limits in males and females subjects and Highest isometric endurance limit exerted in (20%) condition.
For BMI Effect on Isometric Endurance Limit concluded that (limited effect of BMI on isometric endurance limit,
Subjects with medium to small BMI exerted higher endurance limits than those with large BMI with 3.8% for females
subjects, for females subjects with large BMI have highest endurance limits and Highest Isometric endurance limit
exerted in (20%) condition. And Finally for cancer type Effect on Isometric Endurance Limit Concluded that (cancer
Type has a major effect on isometric endurance limit, highest isometric endurance limit exerted by Thyroid cancer
and lymphoma patients and Lowest isometric endurance limit exerted in leukemia). As for future work, researcher
should conduct more future studies, increasing the sample size where more parameters could be included in the
experiments since the literature showed great mean differences in MVC regarding different parameters. to draw a
more definitive conclusion. One could also study the relationship between subjects MVC and survival rates from
AIDS, heart diseases, high blood pressure diseases etc. Finally, an artificial neural network (ANN) model was
developed using neural network toolbox in MATLAB 15, obtained the lowest RMSE and provided the better fit for
the data than the mathematical models, Results show that the machine learning models (neural network) has learned
and fitted the experiment data well. The neural network model outputs accurately resemble the experiment targets for
the three datasets (training, testing, and validation).

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