Physiology & Behavior 227 (2020) 113145

Contents lists available at ScienceDirect

Physiology & Behavior

journal homepage: www.elsevier.com/locate/physbeh

Behavior of the muscle quality index and isometric strength in elderly T

women
⁎
Daniel Jerez-Mayorgaa, , Pedro Delgado-Floodyb, Leonardo Intelangeloc, Christian Campos-Jaraa,
Leonidas Arias-Pobletea, Juan García-Verazaluced, Amador Garcia-Ramose,f, Luis Javier Chirosae
a
Faculty of Rehabilitation Sciences, Universidad Andres Bello, Fernández Concha #700, Santiago. Chile
b
Department of Physical Education. Sports and Recreation. Universidad de La Frontera. Temuco. Chile
c
Musculoskeletal Research Group. University Center for Assistance. Teaching and Research. University of Gran Rosario. Rosario. Argentina
d
Facultad de Organización Deportiva. Universidad Autónoma de Nueva Leon. Mexico
e
Department Physical Education and Sports. Faculty of Sport Sciences. University of Granada. Granada. Spain
f
Department of Sports Sciences and Physical Conditioning. Faculty of Education. Universidad Católica de la Santísima Concepción. Concepción. Chile

A R T I C LE I N FO A B S T R A C T

Keywords: This study aimed (I) to compare the muscle quality index (MQI) and the isometric hip strength between younger
Resistance exercise and older women, and (II) to determine the relationship of the MQI with the sit-to-stand test (STS) and isometric
Sit-to-stand test hip strength in younger and older women. Twenty-eight elderly women (age= 66.2 ± 5.6 years) and twenty
Muscle quality younger women (21.2 ± 2.2 years) participated in the study. The following dependent variables were mea-
Functional electromechanical dynamometer
sured: MQI, STS, body composition, and the peak isometric strength of the hip (PF) which was also normalized
using three different methods (PF/Body Mass, PF/Fat-Free Mass, and PF/Body Mass0,335). Older women pre-
sented a lower PF in hip flexion, extension and external rotation regardless of the method of normalization
(p < 0.001), but the PF of hip abductors and internal rotators was higher for older women (p < 0.05). No
significant differences were found in the MQI between older and younger women (p = 0.443). The MQI was
negatively correlated with the time in the STS in older women (r = -0.706, p < 0.001) and younger women
(r = -0.729, p < 0.001), while the correlations of MQI with isometric hip strength were weaker in older women
(r range: -0.082 – 0.556) and younger women (r range: -0.020 – 0.309). MQI is a clinical and practical tool to
assess the muscular power of the lower extremities.

1. Introduction [19,20,29]. On the contrary, the weakness and atrophy of hip muscles is
evident in subjects with osteoarthritis, and the weakness of hip ab-
The demographic evolution and proportion of older adults is in- ductors has been associated with a higher prevalence of injury in
creasing at an unprecedented rate generating a profound impact on healthy subjects and athletes [28,32]. Clinically, the evaluation of the
global public health [9]. The progressive loss of neuromuscular func- strength of hip muscles can be performed by manual muscle testing
tion with aging entails degrees of disability and reduction of in- [12], isokinetic dynamometers [44], functional electromechanical dy-
dependence during everyday activities [15], fragility [35], risk of namometer (FEMD) [10], and handheld dynamometry [1]. It is also
falling [18], reduction in physical fitness [33], and even the presence of important to consider that certain variables might influence the ex-
pathologies [2]. The decrease in muscular strength has also been as- pression of muscle strength such as body mass and muscle mass, so it is
sociated with the loss of functionality in everyday activities, such as recommended to normalize strength data to avoid the influence of these
walking [27]. variables [4,22]. In this context, different methods have been validated
Previous studies have described the importance of the hip muscles to normalize hip muscle strength according to sex, with specific values
for function, stability and pain in adults and healthy subjects for both strength and torque [4].
[26,36,38]. Possessing high levels of isometric strength in hip muscles On the other hand, the intramuscular changes associated with aging
has been associated with clinical and functional improvements in have led to the generation of muscle quality measurement strategies in
healthy subjects and also in subjects with musculoskeletal conditions the elderly [3,16,17]. Conceptually the muscle quality is defined in two

⁎
Corresponding author.
E-mail address: daniel.jerez@unab.cl (D. Jerez-Mayorga).

https://doi.org/10.1016/j.physbeh.2020.113145
Received 1 July 2020; Received in revised form 7 August 2020; Accepted 9 August 2020
Available online 19 August 2020
0031-9384/ © 2020 Elsevier Inc. All rights reserved.
D. Jerez-Mayorga, et al. Physiology & Behavior 227 (2020) 113145

different ways: (I) the relationship between strength and muscle mass, informed consent was obtained before the beginning of the study. The
and (II) the functional physiological characteristics of muscle tissue, study protocol was approved by the ethical review board from the
including muscle composition, architecture, and ultrastructure [14,17]. Scientific Ethics Committee of the University of Granada, Spain (N°
In this context, body size and lower-body muscle strength and power 619/CEIH/2018). The procedure was in accordance with the latest
are frequently evaluated to explain changes in muscle quality asso- version of the Declaration of Helsinki.
ciated with age [13]. In recent years the muscle quality index (MQI) has
been proposed as a tool to evaluate the muscle power of lower ex- 2.3. Instruments
tremities through anthropometric measurements and the time needed
to complete the sit-to-stand test (STS) [3,40]. Low levels of MQI have A FEMD was used to evaluate isometric hip strength. The FEMD
been associated with a higher probability of dying, low physical func- allows kinetic-tonic control of the movement (0.10–1.5 m/s) and iso-
tion and poor muscle strength [7,16,24]. metric assessment of muscle strength (5–3000 N) at a sampling rate of
In this context, the MQI has been positively correlated with the 1000 Hz (Dynasystem, model research, Granada, Spain) [10,11].
strength and cross-sectional area of the knee extensors [40], but there is
no evidence of the relationship that may exist between the MQI and the 2.4. Procedures
isometric strength of the hip muscles. Therefore, the present study
aimed (I) to compare the MQI and the isometric hip strength using The main experimental session was preceded by a 10-min standar-
different normalization methods between younger and older women, dized warm-up consisting of cycling for 5-min in a leg cycle ergometer,
and (II) to determine the relationship of the MQI with the STS test and joint mobility exercises, and three submaximal contractions of the hip
isometric hip strength in younger and older women. It was hypothe- muscles to become familiar with testing procedures. The characteristics
sised that (I) younger women would present a higher MQI and isometric of the testing protocols are described below.
hip strength compared to older women, and (II) the MQI would be
positively correlated with isometric hip strength and negatively corre- 2.4.1. Anthropometry
lated with the time needed to complete the STS test. Stature was determined using a stadiometer (portable stadiometer
213; SECA; Hamburg; Germany to 0.1 cm). Body composition was as-
sessed using bioelectrical impedance tetrapolar analysis (Tanita BC 330;
2. Materials and methods
Tokyo; Japan) [23]. Leg length was measured manually, applying the
anthropometric measurement protocol [39]. Leg length was defined as
2.1. Study design
the distance (in meters) from the greater trochanter of the femur to the
lateral malleolus (Table 1).
A cross-sectional study was designed to compare the MQI and
maximal hip strength between younger and older women. Two famil-
2.4.2. Isometric hip strength
iarization sessions separated by 48–72 h were conducted before the
Maximum voluntary isometric contraction of the hip muscles of the
main experimental session to explain testing procedures and minimize
non-dominant leg was measured using a FEMD (Dynasystem, Model
potential learning effects. Each familiarization session lasted 30 min.
Research, Granada, Spain). Each subject performed three maximum
Anthropometric measurements (height, body mass, fat mass, fat-free
voluntary isometric contractions for 6 seconds separated by at least 1-
mass, and leg length) were collected in the first familiarization session.
min of rest. Flexion, extension, abduction, adduction, internal rotation
The third session (i.e., main experimental session) was used to evaluate
and external rotation movements of the hip were tested (Fig. 1):
hip muscle strength (flexion, extension, internal rotation, external ro-
tation, abduction, and adduction) and the STS.
A) Hip flexion was evaluated with the subject in a supine position on a
stretcher with the knees outside flexed at 90°. The hip was stabilized
2.2. Subjects with a belt around the stretcher. The axis of the hip joint was
aligned with the axis of the FEMD pull. The thigh was firmly at-
Twenty-eight elderly women (mean ± standard deviation [SD]: tached with a strap to the pulley of the device. The subject was
age = 66.2 ± 5.6 years) and twenty younger women (21.2 ± 2.2 instructed to perform a hip flexion muscle contraction as strong as
years) volunteered to participate in this study (Table 1). All women possible against a fixed resistance provided by the FEMD.
included in this study were recruited through non-probabilistic sam- B) Hip extension was measured with the subject in a prone position on a
pling, were free of radiological evidence of hip osteoarthritis, cardio- stretcher with the knees extended outside the stretcher at 0°. The
vascular, pulmonary, and metabolic conditions, and they did not pre- same protocol described for the hip flexion was used for the hip
sent musculoskeletal pain in the two months preceding the study. extension.
Subjects were informed about the experimental procedures and their C) Hip abduction was measured with the subject lying in a prone posi-
possible risks and benefits before the start of the study. Written tion on a stretcher and the legs in a neutral position. The axis of the
hip joint was perpendicular to the axis of the FEMD pull. The ankle
Table 1 was firmly fixed with a strap attached to the pulley of the device.
Participant characteristics (Mean ± SD). From this initial position, the subject was instructed to perform a
Older women Younger women p-value maximum isometric contraction of hip abductors muscles.
(n = 28) (n = 20) D) Hip adduction followed the same protocol as for the abduction with
the only difference that the axis of the hip joint was perpendicular to
Age (years) 66.2 ± 5.6 21.2 ± 2.2 < 0.001
the axis of the FEMD pulley, but in the opposite direction to how the
Height (cm) 158.36 ± 6.00 160.81 ± 4.50 0.128
Body mass (kg) 70.23 ± 11.18 55.01 ± 6.17 < 0.001 abduction was evaluated. From this initial position, the subject was
Fat mass (kg) 24.00 ± 7.86 14.05 ± 5.14 < 0.001 instructed to perform the maximum possible lateral strength in the
Fat free mass (kg) 42.95 ± 4.17 43.96 ± 6.73 0.554 adduction movement.
Body mass index 28.14 ± 5.16 21.26 ± 1.88 < 0.001 E) Internal hip rotation was evaluated with the subjects sitting and the
(kg•m−2)
Leg length (m) 79.52 ± 5.04 78.42 ± 3.31 0.397
hip at 90°. The hip was stabilized with a belt around the knees to
avoid any countermovement. The axis of the hip joint was perpen-
Values are shown as mean ± SD. dicular to the axis of the FEMD pulley. The ankle was firmly at-
Statistical significance was established at p < 0.05. tached with a strap to the pulley of the device. From this initial

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D. Jerez-Mayorga, et al. Physiology & Behavior 227 (2020) 113145

Fig. 1. Isometric evaluation of the hip musculature using a FEMD, a) flexion, b) extension, c) abduction, d) adduction, e) internal rotation, f) external rotation.

position, the subject was instructed to perform the maximum pos- reported [3].
sible lateral strength.
F) External hip rotation followed the same protocol previously described 2.5. Data extraction
for the internal hip rotation. As in the adduction, the axis of the hip
joint was perpendicular to the axis of the FEMD pulley, but in the The absolute peak force (PF) of each repetition was recorded and
opposite direction to how the internal rotation was evaluated. From used for statistical analyses. In addition, PF was normalized using three
this position, the subject was instructed to perform the maximum different methods for statistical comparisons (I) ratio between PF and
possible lateral strength. body mass (BM) using an allometric exponential factor specific for
women (PF/BM0,335) [4], (II) ratio between PF and BM (PF/BM), and
2.4.3. Sit-to-stand test (III) ratio between PF and fat free mass (PF/FFM).
The time to get up and sit on a chair for ten repetitions was de-
termined. The subjects were instructed to complete the ten repetitions 2.6. Statistical analysis
as quickly as possible. The arms were crossed at the shoulder level to
avoid their influence. Two measurements were collected separated by Descriptive data are presented as mean ± SD. The normal dis-
1-minute of rest. The shortest time was used for further analysis. tribution of the data was verified by the Shapiro-Wilk normality test.
The difference between groups was assessed by t-tests of unpaired
samples with the Cohen's d effect size. The following scale used for
2.4.4. Muscle quality index
interpreting the magnitude of the effect size: < 0.20 = trivial,
The MQI was estimated through the following formula:
0.20–0.59 = small, 0.60–1.19 = moderate, 1.20–2.00 = large, and >
MQI (Watts ) = ((leg length x 0.4) x body mass x gravity x 10)) 2.00 = very large [21]. The Pearson's correlation coefficients were used
to examine the associations of the MQI with the PF of hip muscles, STS
/ Time sit to s tan d
test, and body composition. The criteria to interpret the strength of
This MQI included the length of the leg expressed in meters, 0.4 m, the r coefficients were as follows: trivial (<0.10), small (0.10–0.29),
which is the height of the chair used in the STS, the body mass in moderate (0.30–0.49), high (0.50–0.69), very high (0.70–0.89), and
kilograms, gravity acceleration (9.81 ms−2) and a constant of 10 [40]. practically perfect (>0.90) [21]. A JASP software package (version
The validity and reliability of the MQI measure have been previously 0.9.1.0, http://www.jasp-stats.org) was used for all analyses. Statistical

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D. Jerez-Mayorga, et al. Physiology & Behavior 227 (2020) 113145

Table 2
Comparison of hip strength measures between groups.
Strength measures Older women (n = 28) Young women (n = 20) p-value Effect Size (Cohen's d)

Hip Extension
PF (N) 217.39 ± 58.21 357.90 ± 97.57 < 0.001 1.82 large
PF/BM 3.14 ± 0.86 6.59 ± 2.02 < 0.001 2.36 very large
PF/FFM 5.10 ± 1.76 8.38 ± 2.36 < 0.001 1.60 large
PF/BM0,335 52.45 ± 13.63 93.81 ± 26.33 < 0.001 2.07 very large
Hip Flexion
PF (N) 308.24 ± 118.26 430.30 ± 61.78 < 0.001 1.23 large
PF/BM 4.43 ± 1.49 7.90 ± 1.36 < 0.001 2.40 very large
PF/FFM 14.20 ± 6.88 34.24 ± 12.16 < 0.001 2.12 very large
PF/BM0,335 74.19 ± 26.56 112.63 ± 16.54 < 0.001 1.67 large
Hip Abduction
PF (N) 232.13 ± 67.73 191.75 ± 44.74 0.024 -0.06 trivial
PF/BM 3.39 ± 1.13 3.51 ± 0.85 0.706 0.11 trivial
PF/FFM 5.42 ± 1.79 4.46 ± 0.99 0.035 -0.63 moderate
PF/BM0,335 56.20 ± 16.34 50.14 ± 11.62 0.162 -0.41 small
Hip Adduction
PF (N) 190.32 ± 75.54 128.35 ± 23.48 < 0.001 -1.03 large
PF/BM 2.85 ± 1.38 2.37 ± 0.52 0.144 -0.43 small
PF/FFM 4.49 ± 1.97 3.019 ± 0.63 0.002 -0.94 moderate
PF/BM0,335 46.47 ± 19.52 33.65 ± 6.48 0.007 -0.82 moderate
Hip External Rotation
PF (N) 107 ± 32.88 178.60 ± 103.45 0.001 0.99 moderate
PF/BM 1.54 ± 0.39 3.30 ± 2.03 < 0.001 1.31 large
PF/FFM 2.47 ± 0.70 4.19 ± 2.52 0.001 1.00 moderate
PF/BM0,335 25.84 ± 7.17 46.87 ± 27.64 < 0.001 1.13 moderate
Hip Internal Rotation
PF (N) 247.80 ± 104.24 170.40 ± 30.69 0.002 -0.94 moderate
PF/BM 3.65 ± 1.69 3.14 ± 0.72 0.214 -0.36 small
PF/FFM 5.83 ± 2.66 4.01 ± 0.88 0.005 -0.85 moderate
PF/BM0,335 60.20 ± 25.85 44.70 ± 8.66 0.013 -0.75 moderate

PF = absolute peak force value (N); PF/BM = peak force normalized by body mass; PF/FFM = peak force normalized by fat-free mass; PF/BM0,335 = peak force
normalized by Bazett-Jones et al. [4].
Values are shown as mean ± SD.
Statistical significance was established at p < 0.05.

significance was set at p ≤ 0.05. “Very high” negative correlations were observed between the MQI
and the time in the STS in older (r = -0.706, p = <0.001) and younger
women (r = -0.729, p = <0.001) (Fig. 2).
3. Results In older women MQI presented a positive "high" correlation with the
PF in the hip extension (r = 0.556, p = 0.002) and a positive "mod-
Older women presented a higher BM and fat mass compared to erate" correlation with the PF/BM0.335 in the hip extension (r = 0.461,
younger women (p < 0.001) (Table 1). p = 0.013). On the other hand, in the hip flexion (r = 0.376,
Regardless of the method of normalization, older women presented p = 0.048) and in the internal rotation (r = 0.379, p = 0.046) the PF
a lower PF in hip flexion, extension and external rotation compared to presented a “moderate” positive correlation with the MQI (Table 4).
younger women (p < 0.001). The PF (p = 0.024, ES = -0.06) and PF/
FFM (p = 0.035, ES = -0.63) of hip abductors were higher for older
women compared to younger women. In turn, the PF of hip adductors 4. Discussion
was higher for older women compared to younger women
(p = <0.001, ES = -1.03), PF/FFM (p = 0.002, ES = -0.94), PF/ This study was designed to compare the MQI and the isometric hip
BM0.335 (p = 0.007, ES = -0.82). Older women also presented a higher strength using different normalization methods evaluated by means of a
isometric strength for the internal rotators than younger women using FEMD between younger and older women and to determine the re-
PF (p = 0.002, ES = -0.94), PF/FFM (p = 0.005, ES = -0.85), and PF/ lationship of the MQI with body composition, STS, and hip muscles
BM0.335 (p = 0.013, ES = -0.75) (Table 2). strength. The primary finding of this study revealed that older women
No differences were found in the MQI between older and younger presented a lower isometric peak force in hip flexion, extension and
women (p = 0.443, ES = 0.22), while the time in the STS test was external rotation compared to younger women. Our data showed a
lower for younger women (p = <0.001, ES = -1.79) (Table 3). higher MQI for younger women compared to older women and a lower
time in the STS. In addition, the MQI correlated “very high” with the
Table 3 time in the STS in the two groups. Taken together, this study in-
Comparison of muscle quality index and sit-to-stand test between groups. corporates evidence suggesting that the MQI and hip strength levels are
Older women Younger women p-value Effect Size affected with aging, in addition to an increase in STS time in older
(n = 28) (n = 20) (Cohen's d) women.
The first aim of this study was to investigate the MQI and the hip
MQI (W) 244.39 ± 75.29 260.36 ± 63.2 0.443 0.22 small
strength using different normalization methods in a FEMD. About the
STS (s) 11.63 ± 2.28 8.18 ± 1.23 < 0.001 -1.79 large
MQI, it was shown to be lower in older women (244.3 W) compared to
MQI = Muscle quality index, STS = sit-to-stand test. younger women (260.3 W), but the differences were not statistically
Values are shown as mean ± SD. significant (p = 0.443, ES = 0.22). These results are in line with a
Statistical significance was established at p < 0.05. previous study [25] where subjects with hip osteoarthritis were

4
D. Jerez-Mayorga, et al. Physiology & Behavior 227 (2020) 113145

Fig. 2. Pearson's Correlation between the MQI and the time in the STS in a) younger women, b) older women.

Table 4 the knee extensors [40]. In addition, the STS is considered an overall
Pearson's Correlation coefficients between the muscle quality index and iso- indicator of muscular strength of lower extremities, functional capacity,
metric hip strength. fall predictor and walking speed [5,6,8,42]. In agreement with previous
Variables Older women (n = 28) Younger women (n = 20) studies conducted, the time of execution of the STS was higher in older
Muscle Quality Index (MQI) women (p = <0.001, ES = -1.79) [25]. The longer execution time of
the STS would be associated with a decrease in mobility, increase in
Hip Extension
fragility [30] and a lower MQI [25].
PF (N) 0.556* -0.173
PF/BM 0.213 -0.355 On the other hand, we found that older women presented a lower
PF/FFM 0.300 -0.383 isometric strength in external hip flexors, extensors and external rota-
PF/BM0,335 0.461* -0.243 tors independent of the method of data normalization compared to
Hip Flexion younger women, it is essential to consider that maintaining high levels
PF (N) 0.376* 0.266
PF/BM 0.141 -0.172
of isometric strength induces changes in muscle morphology, favoring
PF/FFM -0.096 0.019 the rapid production of muscle force and induce analgesia in the area
PF/BM0,335 0.316 0.102 [34,37]. In addition, atrophy of the gluteal musculature of the hip is
Hip Abduction associated with the degree of severity of pathologies such as osteoar-
PF (N) 0.265 0.309
thritis [43]. Our results also showed that older adults had greater iso-
PF/BM -0.082 0.004
PF/FFM 0.095 0.024 metric strength in abductors, adductors and internal hip rotators com-
PF/BM0,335 0.148 0.206 pared with younger women, these results differ from what was found in
Hip Adduction the literature. For example, Morcelli et al. [31] found that older women
PF (N) 0.217 -0.020 (which were divided into two groups “fallers” and “non-fallers”) have
PF/BM -0.027 -0.308
less strength and ability to develop rapid strength than younger women
PF/FFM 0.109 -0.323
PF/BM0,335 0.127 -0.134 in abductors and hip adductors. Low levels of hip strength and a slow
Hip External Rotation rate of strength development in older “non-falling” women during hip
PF (N) 0.350 0.092 abduction can increase the risk of falling [31].
PF/BM 0.046 -0.019
The second aim of our study was to determine the relationship be-
PF/FFM 0.220 -0.023
PF/BM0,335 0.274 0.052 tween the MQI and several variables such as the time in the STS test and
Hip Internal Rotation hip muscles strength. In this context, we found a “very high” negative
PF (N) 0.379* -0.105 correlation between MQI and the time of the STS in both older and
PF/BM 0.142 -0.364 younger women. MQI has been correlated with the time of the STS in
PF/FFM 0.260 -0.383
subjects with hip osteoarthritis and young adults finding high and
PF/BM0,335 0.301 -0.212
moderate relationships, respectively [25]. It is important to consider
PF = peak force (N); PF/BM = normalized by body mass; PF/ this relationship because the STS is an indicator of functional in-
FFM = normalized by fat-free mass; PF/BM0,335 = normalized by Bazett-Jones dependence in older adults [41], since the ability to transfer from sit-
et al. [4]. ting to standing position is a prerequisite for functional independence
⁎
Statistical significance was established at p < 0.05. [41].
The main limitation of the present study was the determination of
compared to older adults without hip osteoarthritis and young adults, muscle quality through an index that includes body measurements and
revealing that the two groups of older adults had lower levels of MQI the time of the STS, not being considered other dimensions of muscle
compared to young adults . In this context, Brown et al. [7] has asso- quality such as muscle composition, architecture and ultrastructure that
ciated presenting a lower MQI with a higher probability of death in can deliver a specific diagnosis of muscle function [17]. Also, the
women over 65 years, those who were in the lowest power quintiles strength of the knee flexors and extensors was not evaluated; according
(50.3 W to 84.9 W), the results of our study indicate that older and to the mechanism of the STS, the muscle strength levels of these mus-
younger women would be in the highest quintile (>144.8 W). Strength cles could be related to the MQI [40]. In addition, the levels of physical
training using exercises such as squats, splits squats and leg extensions activity and sedentary habits that could determine functional levels
have been shown to generate increases of 18–22% in the MQI in older among older and younger women were not evaluated.
adults [16]. This is because the calculation of the MQI incorporates the In conclusion, older women presented lower isometric strength in
time in the STS. This test evaluates the capacity for generating force in hip flexion, extension and external rotation independent of the method

5
D. Jerez-Mayorga, et al. Physiology & Behavior 227 (2020) 113145

of normalization of maximal isometric strength compared to younger [21] W.G. Hopkins, S.W. Marshall, A.M. Batterham, J. Hanin, Progressive statistics for
women. In addition, younger women have a higher MQI without sig- studies in sports medicine and exercise science, Med. Sci. Sports Exerc. 41 (1)
(2009) 3–13, https://doi.org/10.1249/MSS.0b013e31818cb278.
nificant differences between groups. Additional research should in- [22] S. Jaric, S. Radosavljevic-Jaric, H. Johansson, Muscle force and muscle torque in
vestigate whether these findings are present in other populations with humans require different methods when adjusting for differences in body size, Eur.
different pathologies and conditions. J. Appl. Physiol. 87 (3) (2002) 304–307, https://doi.org/10.1007/s00421-002-
0638-9.
Based on the results obtained in the present investigation, we con- [23] S a., C.T. Jebb, D Doman, PR Murgatroyd, AM. Prentice, Evaluation of the novel
sider that the MQI is a clinical and practical tool to evaluate the mus- Tanita body-fat analyser to measure body composition by comparison with a four-
cular power of lower extremities and can be useful for trainers and compartment model, J. Nutr. (83) (2000) 115–122.
[24] D.A. Jerez, R. Machado, E. Cerda, AB1400-HPR Muscle quality index in obese
physiotherapists to determine the muscle quality and functional capa- subjects with hip osteoarthritis, Ann. Rheum. Dis. 77 (Suppl 2) (2018) 1835,
city of older and younger women with low levels of strength. https://doi.org/10.1136/annrheumdis-2018-eular.4586.
[25] D. Jerez-Mayorga, L.J. Chirosa Rios, A. Reyes, P. Delgado-Floody, R. Machado
Payer, I.M. Guisado Requena, Muscle quality index and isometric strength in older
References
adults with hip osteoarthritis, PeerJ. 7 (2019) e7471, https://doi.org/10.7717/
peerj.7471.
[1] C.M. Arnold, K.D. Warkentin, P.D. Chilibeck, C.R.A. Magnus, The reliability and [26] K. Khayambashi, N. Ghoddosi, R.K. Straub, C.M. Powers, Hip muscle strength
validity of handheld dynamometry for the measurement of lower-extremity muscle predicts noncontact anterior cruciate ligament injury in male and female athletes: a
strength in older adults, J. Strength Cond. Res. 24 (3) (2010) 815–824, https://doi. prospective study, Am. J. Sports Med. 44 (2) (2015) 355–361, https://doi.org/10.
org/10.1519/JSC.0b013e3181aa36b8. 1177/0363546515616237.
[2] M.H. Arokoski, J.P. Arokoski, M. Haara, M. Kankaanpaa, M. Vesterinen, [27] J. Kim, S. Kuno, R. Soma, K. Masuda, K. Adachi, T. Nishijima, M. Okada,
L.H. Niemitukia, H.J. Helminen, Hip muscle strength and muscle cross sectional Relationship between reduction of hip joint and thigh muscle and walking ability in
area in men with and without hip osteoarthritis, J. Rheumatol. 29 (10) (2002) elderly people, Jap. J. Phys. Fitness Sports Med. 49 (5) (2000) 589–596, https://
2185–2195. doi.org/10.7600/jspfsm1949.49.589.
[3] S. Barbat-Artigas, Y. Rolland, M. Zamboni, M. Aubertin-Leheudre, How to assess [28] A. Loureiro, P.M. Mills, R.S. Barrett, Muscle weakness in hip osteoarthritis: a sys-
functional status: a new muscle quality index, J. Nutr. Health Aging 16 (1) (2012) tematic review, Arthritis Care Res. 65 (3) (2013) 340–352, https://doi.org/10.
67–77. 1002/acr.21806.
[4] D.M. Bazett-Jones, S.C. Cobb, M.N. Joshi, S.E. Cashin, J.E. Earl, Normalizing hip [29] D. Lum, T.M. Barbosa, Brief review: effects of isometric strength training on
muscle strength: establishing body-size-independent measurements, Arch. Phys. strength and dynamic performance, Int. J. Sports Med. 40 (6) (2019) 363–375,
Med. Rehabil. 92 (1) (2011) 76–82, https://doi.org/10.1016/j.apmr.2010.08.020. https://doi.org/10.1055/a-0863-4539.
[5] R.W. Bohannon, Test-retest reliability of the five-repetition sit-to-stand test: a sys- [30] H. Mehmet, A.W.H. Yang, S.R. Robinson, What is the optimal chair stand test
tematic review of the literature involving adults, J. Strength Cond. Res. 25 (11) protocol for older adults? A systematic review, Disabil. Rehabil. (2019) 1–8,
(2011) 3205–3207, https://doi.org/10.1519/JSC.0b013e318234e59f. https://doi.org/10.1080/09638288.2019.1575922.
[6] R.W. Bohannon, D.J. Bubela, S.R. Magasi, Y.C. Wang, R.C. Gershon, Sit-to-stand [31] M.H. Morcelli, D.M. Rossi, A.H. Karuka, L.F. Crozara, C.Z. Hallal, N.R. Marques,
test: Performance and determinants across the age-span, Isokinet Exerc. Sci. 18 (4) M.T. Navega, Peak torque, reaction time, and rate of torque development of hip
(2010) 235–240, https://doi.org/10.3233/IES-2010-0389. abductors and adductors of older women, Physiother. Theory Pract. 32 (1) (2016)
[7] J.C. Brown, M.O. Harhay, M.N. Harhay, The muscle quality index and mortality 45–52, https://doi.org/10.3109/09593985.2015.1091870.
among males and females, Ann. Epidemiol. 26 (9) (2016) 648–653, https://doi.org/ [32] M.D. Mucha, W. Caldwell, E.L. Schlueter, C. Walters, A. Hassen, Hip abductor
10.1016/j.annepidem.2016.07.006. strength and lower extremity running related injury in distance runners: A sys-
[8] S. Buatois, D. Miljkovic, P. Manckoundia, R. Gueguen, P. Miget, G. Vancon, tematic review, J. Sci. Med. Sport 20 (4) (2017) 349–355, https://doi.org/10.1016/
A. Benetos, Five times sit to stand test is a predictor of recurrent falls in healthy j.jsams.2016.09.002.
community-living subjects aged 65 and older, J. Am. Geriatr. Soc. 56 (8) (2008) [33] A. Munoz-Arribas, S. Vila-Maldonado, R. Pedrero-Chamizo, L. Espino, N. Gusi,
1575–1577, https://doi.org/10.1111/j.1532-5415.2008.01777.x. G. Villa, A. Gomez-Cabello, [Physical fitness evolution in octogenarian population
[9] J.A. Cauley, An overview of sarcopenic obesity, J. Clin. Densitom. 18 (4) (2015) and its relationship with a sedentary lifestyle], Nutr. Hosp. 29 (4) (2014) 894–900,
499–505, https://doi.org/10.1016/j.jocd.2015.04.013. https://doi.org/10.3305/nh.2014.29.4.7212.
[10] E. Cerda Vega, D. Jerez-Mayorga, R. Machado Payer, C. Campos Jara, I. Guzman- [34] D.J. Oranchuk, A.G. Storey, A.R. Nelson, J.B. Cronin, Isometric training and long-
Guzman, A. Reyes Ponce, L.J. Chirosa, Validity and reliability of evaluating hip term adaptations: Effects of muscle length, intensity, and intent: A systematic re-
abductor strength using different normalization methods in a functional electro- view, Scand. J. Med. Sci. Sports 29 (4) (2019) 484–503, https://doi.org/10.1111/
mechanical device, PLoS One 13 (8) (2018) e0202248, , https://doi.org/10.1371/ sms.13375.
journal.pone.0202248. [35] M.T. Puts, P. Lips, D.J. Deeg, Sex differences in the risk of frailty for mortality
[11] C. Chamorro, C.D.L. Fuente, D. Jerez, C. Campos, L.J. Chirosa, Reliability of independent of disability and chronic diseases, J. Am. Geriatr. Soc. 53 (1) (2005)
shoulder rotators isometric strength test using a novel pulley electromechanical 40–47, https://doi.org/10.1111/j.1532-5415.2005.53008.x.
dynamometer influence of the assessment position, Asian. J. Sports Med. 9 (2) [36] T.H. Retchford, K.M. Crossley, A. Grimaldi, J.L. Kemp, S.M. Cowan, Can local
(2018) e60406, https://doi.org/10.5812/asjsm.60406. muscles augment stability in the hip? A narrative literature review, J.
[12] K.M. Conable, A.L. Rosner, A narrative review of manual muscle testing and im- Musculoskelet. Neuronal Interact 13 (1) (2013) 1–12.
plications for muscle testing research, J. Chiropr. Med. 10 (3) (2011) 157–165, [37] E. Rio, M. van Ark, S. Docking, G.L. Moseley, D. Kidgell, J.E. Gaida, J. Cook,
https://doi.org/10.1016/j.jcm.2011.04.001. Isometric contractions are more analgesic than isotonic contractions for patellar
[13] R. Correa-de-Araujo, M.O. Harris-Love, I. Miljkovic, M.S. Fragala, B.W. Anthony, tendon pain: an in-season randomized clinical trial, Clin. J. Sport Med. 27 (3)
T.M. Manini, The need for standardized assessment of muscle quality in skeletal (2017) 253–259, https://doi.org/10.1097/jsm.0000000000000364.
muscle function deficit and other aging-related muscle dysfunctions: a symposium [38] T.R. Santos, B.A. Oliveira, J.M. Ocarino, K.G. Holt, S.T. Fonseca, Effectiveness of hip
report, Front. Physiol. 8 (87) (2017), https://doi.org/10.3389/fphys.2017.00087. muscle strengthening in patellofemoral pain syndrome patients: a systematic re-
[14] A.J. Cruz-Jentoft, A.A. Sayer, Sarcopenia, Lancet 393 (10191) (2019) 2636–2646, view, Braz. J. Phys. Ther. 19 (3) (2015) 167–176, https://doi.org/10.1590/bjpt-rbf.
https://doi.org/10.1016/S0140-6736(19)31138-9. 2014.0089.
[15] T.J. Doherty, Invited review: aging and sarcopenia, J. Appl. Physiol. 95 (4) (2003) [39] M.J. Marfell-Jones, A.D. Stewart, J.H. De Ridder, International Standards for
1717–1727, https://doi.org/10.1152/japplphysiol.00347.2003. Anthropometric Assessment, (2012).
[16] M.S. Fragala, D.H. Fukuda, J.R. Stout, J.R. Townsend, N.S. Emerson, C.H. Boone, [40] Y. Takai, M. Ohta, R. Akagi, H. Kanehisa, Y. Kawakami, T. Fukunaga, Sit-to-stand
J.R. Hoffman, Muscle quality index improves with resistance exercise training in test to evaluate knee extensor muscle size and strength in the elderly: a novel ap-
older adults, Exp. Gerontol. 53 (2014) 1–6, https://doi.org/10.1016/j.exger.2014. proach, J. Physiol. Anthropol. 28 (3) (2009) 123–128.
01.027. [41] R.C. van Lummel, S. Walgaard, A.B. Maier, E. Ainsworth, P.J. Beek, J.H. van Dieën,
[17] M.S. Fragala, A.M. Kenny, G.A. Kuchel, Muscle quality in aging: a multi-dimen- The instrumented sit-to-stand test (iSTS) has greater clinical relevance than the
sional approach to muscle functioning with applications for treatment, Sports Med. manually recorded sit-to-stand test in older adults, PLoS One 11 (7) (2016)
45 (5) (2015) 641–658, https://doi.org/10.1007/s40279-015-0305-z. e0157968, , https://doi.org/10.1371/journal.pone.0157968.
[18] M.R. Franco, L.S. Pereira, P.H. Ferreira, Exercise interventions for preventing falls [42] N. Yanagawa, T. Shimomitsu, M. Kawanishi, T. Fukunaga, H. Kanehisa,
in older people living in the community, Br. J. Sports Med. 48 (10) (2014) 867–868, Relationship between performances of 10-time-repeated sit-to-stand and maximal
https://doi.org/10.1136/bjsports-2012-092065. walking tests in non-disabled older women, J. Physiol. Anthropol. 36 (1) (2016) 2,
[19] S. Gafner, C.H.G. Bastiaenen, P. Terrier, I. Punt, S. Ferrari, G. Gold, P. Activity, https://doi.org/10.1186/s40101-016-0100-z -2.
Evaluation of hip abductor and adductor strength in the elderly: a reliability study, [43] A. Zacharias, R.A. Green, A. Semciw, D.J. English, T. Kapakoulakis, T. Pizzari,
Eur. Rev. Aging Phys. Act. 14 (1) (2017) 5, https://doi.org/10.1186/s11556-017- Atrophy of hip abductor muscles is related to clinical severity in a hip osteoarthritis
0174-6. population, Clin. Anat. 31 (4) (2018) 507–513, https://doi.org/10.1002/ca.23064.
[20] M. Hall, T.V. Wrigley, J. Kasza, F. Dobson, Y.H. Pua, B.R. Metcalf, K.L. Bennell, [44] F.Y. Zapparoli, M. Riberto, Isokinetic evaluation of the hip flexor and extensor
Cross-sectional association between muscle strength and self-reported physical muscles: a systematic review, J. Sport Rehabil. 26 (6) (2017) 556–566, https://doi.
function in 195 hip osteoarthritis patients, Semin. Arthritis Rheum. 46 (4) (2017) org/10.1123/jsr.2016-0036.
387–394, https://doi.org/10.1016/j.semarthrit.2016.08.004.