Experimental Gerontology 53 (2014) 1–6

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Experimental Gerontology
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Short report

Muscle quality index improves with resistance exercise training in

older adults
Maren S. Fragala ⁎, David H. Fukuda, Jeffrey R. Stout, Jeremy R. Townsend, Nadia S. Emerson, Carleigh H. Boone,
Kyle S. Beyer, Leonardo P. Oliveira, Jay R. Hoffman
Institute of Exercise Physiology and Wellness, University of Central Florida, Orlando, FL, USA

a r t i c l e i n f o a b s t r a c t

Article history: Introduction: Sarcopenia is currently best described as an age-related decline in skeletal muscle mass and
Received 21 October 2013 function. However, no consensus exists as to how to best quantify muscle function in older adults. The muscle
Received in revised form 2 January 2014 quality index (MQI) was recently recommended as an ideal evidence-based assessment of functional status in
Accepted 29 January 2014 older adults. Nevertheless, the usefulness of MQI to assess physical function is limited by whether it is reflective
Available online 6 February 2014
of muscle qualitative changes to an intervention. Thus, the purpose of this investigation was to determine
whether MQI changes in response to resistance exercise training and detraining and how such changes correspond
Section Editor: Christiaan Leeuwenburgh
to other recommended measures of physical function proposed by suggested definitions of sarcopenia.
Keywords: Methods: Twenty-five older adults (70.6 ± 6.1 y; BMI = 28.1 ± 5.4 kg · m−2) completed a 6-week resistance
Sarcopenia training program in a wait-list controlled, cross-over design. MQI was determined as power output from timed
Power sit to stand (STS), body mass, and leg length. Gait speed, hand grip strength, get-up-and-go and lean body mass
Intervention (LBM) were evaluated before and after exercise training and detraining. MQI and functional changes to training
Aging and detraining were evaluated with repeated measures ANOVA and clinical interpretations of magnitude based in-
Elderly ferences.
Strength
Results: Short term resistance training significantly and clinically improved MQI (203.4 ± 64.31 to 244.3 ±
Resistance training
82.92 W), gait time (1.85 ± 0.36 to 1.66 ± 0.27 s) and sit to stand performance (13.21 ± 2.51 to 11.05 ± 1.58 s).
Changes in LBM and hand grip strength were not significant or clinically meaningful. De-training for 6-
weeks did not result in significant changes in any measure from post-training performance.
© 2014 Elsevier Inc. All rights reserved.

1. Introduction
Sarcopenia, the age-related loss in skeletal muscle mass is closely
related to mobility and functional impairments common with advanced
age (Fiatarone et al., 1994; Foldvari et al., 2000; Janssen, 2006).The rel-
ative importance of muscle function for sarcopenic outcomes has led to
more recent approaches to define sarcopenia incorporating muscle
function into the diagnostic criteria (Cruz-Jentoft et al., 2010; Lauretani
et al., 2003). However, the ability to diagnose sarcopenia and develop
meaningful treatments has been complicated by the complexities of
muscle function and differing rates of age-related changes. In particular,
the rate that muscle strength declines is faster than the rate that muscle
mass declines (Goodpaster et al., 2006). Similarly, the rate at which
muscle power declines is even more rapid than the concomitant loss
of muscle strength and mass (Frontera et al., 1991; Goodpaster et al.,
Abbreviations: AED, Automatic external defibrillator; BMI, Body mass index; CPR,
Cardio-pulmonary resuscitation; DEXA, Dual energy X-ray absorptiometry; ICC,
Intra-class correlation coefficients; LBM, Lean body mass; MQI, Muscle quality index;
STS, Sit to stand; SEM, Standard error of measurement; SWC, Smallest worthwhile change.
⁎ Corresponding author at: Sport and Exercise Science, University of Central Florida,
4000 Central Florida Blvd, Orlando, FL 32816, USA. Tel.: +1 407 823 3877.
E-mail address: Maren.fragala@ucf.edu (M.S. Fragala).
2006; Hakkinen et al., 1996). Such temporal discrepancies reveal more
intricate musculoskeletal changes associated with sarcopenia and
aging than simply a loss of muscle tissue. Such changes are likely attrib-
uted to the quality of the muscle tissue (Goodpaster et al., 2001).
Skeletal muscle quality has been described in many ways ranging
from muscle composition and density to muscle function per muscle
mass to muscle's metabolic processes (Barbat-Artigas et al., 2012).
Muscle quality is often assessed indirectly as a relative performance
indicator defined as muscle strength per muscle mass (Moritani and
deVries, 1979). When defined in this way, muscle quality declines are
associated with advanced age (Lindle et al., 1997; Lynch et al., 1999).
While aging attenuates muscle's hypertrophic responses to resistance
training (Welle et al., 1996), it does not appear to impair muscle quality
adaptations to resistance exercise in older adults (Welle et al., 1996).
Hence, muscle quality may present a meaningful, informative, and sen-
sitive target to monitor sarcopenia status and treatment efficacy,
beyond routine measures of muscle mass. In particular, a simple muscle
qualitative assessment that can be conducted feasibly during routine
clinical examinations may have the broadest impact for assessment
and evaluation. Functional measures, by way of muscle quality estima-
tion, may allow for clinicians to account for the interaction between
declining muscularity and intramuscular fat infiltration which may be

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http://dx.doi.org/10.1016/j.exger.2014.01.027
2 M.S. Fragala et al. / Experimental Gerontology 53 (2014) 1–6
misinterpreted or neglected for by standard sarcopenic evaluation
involving only muscle mass in aging adults.
Recently, Barbat-Artigas et al. (2012) reviewed and recommended
the muscle quality index (MQI) as a “clinical screening tool to detect
individuals at risk of physical incapacities based on muscle quality.”
The MQI calculates muscle power from anthropometric measures
(e.g. leg length and body mass) and timed chair rises (Takai et al.,
2009). The MQI assessment is particularly informative in comparison
to other measures because it evaluates specific lower extremity function
that is related to ambulation, as opposed to non-muscle group specific
measures of handgrip strength. In addition, the MQI is a more complete
index of muscle quality than relative strength since it incorporates the
velocity at which muscle shortens (i.e. muscle power), which is reflec-
tive of the neuromuscular component. Furthermore, the assessment is
clinically relevant, since it is calculated from the common sit to stand
test. Utilizing the familiar timed sit to stand test, the assessment is
appropriate for older persons who may have physical limitations, safety
concerns and/or sarcopenia. Moreover, prior research has shown that
the ability to rise from a chair is related to functional independence in
older adults (Corrigan and Bohannon, 2001). MQI can be distinguished
from the common sit to stand test as, as it incorporates anthropometric
measures of body mass and leg length to which have previously been
shown to alter the relationship between chair rise performance and
leg strength (Takai et al., 2009). The MQI has been shown to be strongly
correlated to the cross-sectional area of the knee extensors (r = 0.801)
and force of the knee extensors (r = 0.730) in older adults, while timed
sit to stand was not (Takai et al., 2009).
While the MQI has been recommended as the “best clinical measure
to assess muscle power” (Barbat-Artigas et al., 2012), no proposed
definitions of sarcopenia have incorporated the potentially more sensi-
tive muscle quality measure of muscle power into the proposed criteria.
For muscle quality to become an appropriate target of treatment strate-
gies for sarcopenia, we need to generate a better understanding of the
adaptability of aspects of muscle quality at the clinical level. Hence,
the purpose of the present investigation was to examine if and how
MQI changes in response to a resistance training and detraining
intervention in older adults and how such changes compare to other
measures of physical function commonly measured in older adults.
2. Materials and methods
2.1. Experimental approach to the problem
To determine the effects of resistance training and detraining on
muscle quality index (MQI), older adult volunteers completed two
phases of the experimental protocol, both of which included a 6-week
resistance training program, in a wait-list controlled, cross-over design
(Fig. 1). Volunteers were randomized into exercise group 1 or exercise
group 2. Exercise group 1 completed 6-weeks of resistance training in
Phase 1 and 6-weeks of detraining (no resistance training) in Phase 2.
Exercise group 2 completed a 6-week control period of no resistance
Fig. 1. Study design.
exercise intervention where they were instructed to maintain their
normal daily activities in Phase 1 followed by 6-weeks of resistance
exercise training in Phase 2. All participants were tested at 3 time points
separated by 6-weeks of resistance exercise training either proceeded
by detraining (Phase 1) or preceded by a control condition (Phase 2).
MQI and functional measures were determined before and after Phase
1 and Phase 2 at weeks 0, 6, and 12. Reliability intra-class correlation
coefficients (ICC) and standard error of measurements (SEM) were
computed from 11 participants in the control group.
2.2. Participants
Twenty-five older adults volunteered for the study (70.5 ± 6.2 y;
168.4 ± 9.4 cm; 81.4 ± 19.0 kg). Participants were recruited from a
variety of sources including word of mouth, flyers, and informational
presentations. Participants were required to be over age 60 y and phys-
ically cleared for exercise participation according to a health history
questionnaire or physicians clearance. Physician clearance was required
for any participant over age 70 y or any potentially positive risk factor
as indicated on the medical history questionnaire. Individuals classified
as “high risk” for exercise by having a cardiovascular, pulmonary, or
metabolic disease, or one or more cardiovascular signs and symptoms
were excluded from participation. Participants were randomly assigned
to either group 1 (n = 13) or group 2 (n = 12). Participants were
recruited so that an equal number of men and women was randomized
to each group. During both phases of the protocol, all participants were
instructed to follow their normal diets. Two women completed pre-
testing but did not complete all time points due to personal reasons
not associated with the study. One man chose not to complete the
week 12 DEXA test. Thus, 23 individuals were included in the final anal-
ysis, with n = 22 for the body composition analysis. Participants were
informed of study procedures, and provided written informed consent
prior to enrolling in the study. All study procedures were reviewed
and approved by the Institutional Review Board for the Protection of
Human Subjects at the University of Central Florida.
2.3. Measures
2.3.1. Anthropometrics
Body mass and stature were measured following standardized
anthropometric protocols on a digital scale and an upright standiometer
during each testing occasion. Body mass index was calculated from
these measures as kg · m−2.
2.3.2. Dual-energy X-ray absorptiometry
Total body composition was evaluated using dual energy X-ray
absorptiometry (DEXA) technologies obtained on a whole body scan.
All DEXA scans were ordered by a licensed physician in the state of
Florida and were performed in the Body Composition Laboratory by
a technician licensed in the state of Florida.
 M.S. Fragala et al. / Experimental Gerontology 53 (2014) 1–6
Fig. 2. Magnitude based inferences for improvement or reduction in functional measures.
Data are reported as [mean (post-pre) ± 90% confidence limits].The smallest worthwhile
change (SWC) trivial zone was set at 20% of the pre-training standard deviation for each
variable. For figure clarity, changes were represented as a factor of the SWC in order
to compare values of differing units and determined by dividing the mean and 90%
confidence intervals of each variable by its corresponding SWC value. LBM = Lean body
mass, GUG = Get-up and go, Gait = Gait time, Grip = Hand grip strength, MQI = Muscle
quality index.
2.3.3. Hand grip strength
Hand-grip strength was measured in kilograms (kg) as maximal
isometric force achieved on a hand grip dynamometer (JAMAR 5030J1)
(ICC3,1 = 0.959, SEM = 3.1 kg). This test was administered with partic-
ipants sitting square in a standard chair with feet flat on the floor and the
elbow bent at 90°. The dynamometer was placed in the hand and adjust-
ed so the palm side of the grip was at the palm and the front end was
lined up between the joints of the medial and distal phalanges. The
grip size was adjusted so that the second metacarpals were flat with
a 90° bend at the knuckles. Participants were asked to squeeze the
strength gauge as hard as possible for 3–5 s. Three trials on each hand
were performed with 30-s of rest given between trials. The maximum
value attained from any trial was used in subsequent analysis.
2.3.4. Gait time
Gait time was recorded as the time in seconds required to walk an
8-ft course at normal walking gait speed (ICC3,1 = 0.689, SEM = 0.19 s).
Participants were allowed to use any usual walking aids. Spotters
walked along the side of the older volunteer's during the test to ensure
safety if balance was in question. Time was recorded with the Brower
Timing Systems (Draper, Utah) laser timing device. Time began when
the volunteer began to move and lift a foot off of the sensor and stopped
when one foot (completely) crosses the end line (8-ft mark). Two trials
were completed. The average of the two trials was used in subsequent
analysis.
2.3.5. Get-up & Go
The Get-up & Go test measured the time taken in seconds for
participants to stand from a seated position in a chair, walk 3 m,
turn, return to the chair and sit (ICC3,1 = 0.783, SEM = 0.42 s). During
this test participants were not allowed to use their arms to push off of
the chair or for support during the test. Spotters were in place to ensure
that older participants could safely complete the test.
2.3.6. Timed sit to stand
Time to complete five consecutive full chair rises from a seated
position in a standard armless chair was measured in seconds
(ICC3,1 = 0.723, SEM = 1 s). Participants were instructed to stand
as fast as possible from a sitting position in a chair five times consecu-
tively with the arms folded across the chest so that they could not assist
with the movement. Spotters were in place to ensure that participants
were not at risk of falling and the testing chair was secured against
a plyometric block to ensure that it remained secured throughout
the test.
3
2.3.7. Muscle quality index
Muscle quality index (MQI) was measured according to methods
devised by Takai et al. (Takai et al., 2009) (ICC3,1 = 0.907, SEM =
21.91 W). MQI uses timed sit to stand, individual body mass, and
leg length to calculate a power index reported in watts (W). According
to the following equation (Takai et al., 2009):
MQI ¼ ððleg length x 0:4Þ  body mass  gravity  10Þ=Time sit‐stand
where leg length was defined as the distance (in meters) from the great
trochanter of the femur to the malleolus lateralis as determined from the
full body scan on scan on the DEXA. The coefficient of 0.4 (m) represents
the height of the standard chair used for the chair rise test, the force
of gravity was represented by 9.81 m s− 2, and 10 represents a con-
stant from the original equation (Takai et al., 2009). The validity
and reliability of the MQI measure have been previously reported
(Takai et al., 2009).
2.3.8. Strength training protocol
Before beginning the resistance training program, all participants
completed two familiarization sessions where proper form and tech-
nique of each exercise were learned and the starting load resistance
for each exercise was assigned. Training intensity was set to a load
corresponding to perceived moderate intensity. The OMNI scale of
perceived exertion was used to assess perceived difficulty (0 = sitting
or no exertion to 10 = all-out effort). The program consisted of two
workouts per week with sessions lasting 1 to 1 ½ h. Each workout
was separated by at least 48 h to allow for adequate recovery. The train-
ing program consisted of an individualized, periodized, full-body
program including exercises of varying progressions of all of the
major muscle groups. Exercises included machine-based exercises
(leg extensions, leg curls, seated rows, and lat pull-downs), body weight
exercises (squats, split squats, abdominals, calf raises, and modified
stiff-legged dead-lifts) and free weight exercises (biceps curls, chest
presses, shoulder presses, triceps extensions and progressions for
body weight exercises). Acute program variables varied progressively
throughout the 6-weeks, but generally consisted of three (3) sets of 8
to 15 repetitions of 7 to 8 exercises at moderate intensity (perceived
exertion of 5–6 on a 10 point scale). Resistance was adjusted to allow
for the completion of the designated repetition range and to ensure
that participants were challenged to the specified perceived exertion
rating. Each workout session began with a standardized dynamic
warm-up consisting of body weight squats, high knee walking, and
limb rotations and terminated with an appropriate cool down. The exer-
cise program followed the recommended guidelines for older adults by
the American College of Sports Medicine and the National Strength
and Conditioning Association and was supervised by National Strength
and Conditioning Association's Certified Strength and Conditioning
Specialists, who were also certified in cardio-pulmonary resuscitation
(CPR) and automatic external defibrillation (AED).
2.3.9. Control period protocol
During the 6-week control (Phase 1) or detraining period (Phase 2),
participants completed all testing procedures and were instructed to
maintain their normal level of daily physical activity throughout the
study period. Participants assigned to exercise group 2 were told that
they were on the “wait-list” for the exercise program and were able to
enroll in the exercise program following mid-testing.
2.4. Analysis
Data were analyzed using separate repeated measures ANOVA to
evaluate dependent variable changes by intervention and group for
Phase 1 and Phase 2. In the event of a significant F score, a post-hoc
paired t-test was used to determine pairwise differences. Independent
sample t-tests were run to evaluate baseline differences between the
4 M.S. Fragala et al. / Experimental Gerontology 53 (2014) 1–6
groups. In order to compare the relative changes of each functional
outcome, the combined values of the training periods for each group
(n = 23) were evaluated using a magnitude-based inference approach.
Changes in functional measures were analyzed using magnitude based
inferences, calculated from 90% confidence intervals, as previously de-
scribed (Hopkins et al., 2009). Change scores reflecting improvement
or reduction in functionality were analyzed using the p value from
dependent t-tests to determine a mechanistic inference. Qualitative
inferences were based upon the chances that the true magnitude of
the effect at post-training was substantially improved or reduced com-
pared to pre-training values, and was assessed as: b1% almost certainly
reduced, 1–5% very likely reduced, 5–25% likely reduced, 25–75% possi-
bly improved, 75–95% likely improved, 95–99% very likely improved
and N 99% almost certainly improved. If there was a greater than 5%
chance that the true value was both improved and reduced, the effect
was considered mechanistically unclear. The smallest non-trivial
change, or smallest worthwhile change, was set at 20% of the pre-
training standard deviation. Significance for this study was set a priori
at p ≤ 0.10. A significance of p ≤ 0.10 was elected to reduce the likeli-
hood of accepting the null hypothesis and missing detection of an
important change in this first study to explore changes in MQI. Data
are presented as mean ± SD unless otherwise stated.
3. Results
The baseline descriptive characteristics and physical function mea-
sures of the study participants are shown in Tables 1 and 2, respectively.
Groups were similar in age, anthropometrics and physical function at
baseline, with the exception of get-up and go time where Group 2 was
faster (p = 0.042).
3.1. Phase 1 (training vs. control)
Significant interactions between exercise training and control
were observed for MQI (p = 0.062), gait speed (p = 0.035), and sit
to stand time (p = 0.042) (Table 2). MQI increased by 22% (199.06
to 242.88 W), gait speed improved by 15% (1.92 to 1.64 s), and sit
to stand time improved by 18% (14.19 to 11.57 s) from pre to post-
testing after 6-weeks of resistance exercise in group 1. No inter-
vention by time interactions were observed for hand grip strength,
get up and go or LBM in phase 1 (p N 0.10). No significant changes
in functional measures were observed in the control group (group
2) during phase 1.
3.2. Phase 2 (training vs. de training)
Significant interactions between training and de-training were ob-
served for MQI (p = 0.001), sit to stand (p = 0.000), and gait speed
(p = 0.076) in phase 2. MQI increased by 18% (208.18 to 244.99 W),
sit to stand time improved by 14% (12.14 to 10.48 s), and gait
speed improved by 5% (1.77 to 1.68 s) from pre to post-testing
after 6-weeks of resistance exercise in group 2. No intervention by
time interactions were observed for hand grip strength, get up and
go or LBM in phase 2 (p N 0.10). Post-hoc pairwise comparisons re-
vealed that six weeks of detraining did not result in significant losses
(p N 0.10) in improvements that were attained during the training
Table 1
Baseline descriptive characteristics of study participants.
Group 1 (N = 12) Group 2 (N = 11)
Age (y) 70.8 ± 6.8 69.6 ± 5.5
Women:Men W = 4; M = 8 W = 6; M = 5
Body mass (kg) 84.5 ± 20.8 78.5 ± 17.9
Height (m) 1.71 ± 0.11 1.67 ± 0.08
BMI (kg · m−2) 28.6 ± 5.5 28.2 ± 5.4
Body fat (%) 36.2 ± 9.2 35.2 ± 9.5
regimen (Table 2). Performance measures changed by 1.0 to 4.8%
between post-training (week 6) and detraining (week 12) in group 1.
3.3. Clinical changes in functional measures
Magnitude-based inference analyses of changes in functional mea-
sures for the combined training groups (n = 23) are presented in
Fig. 2 and Table 3. Clinical interpretations based on smallest worthwhile
change limits reveal that MQI and STS “most likely improved” and GUG
and gait speed, “very likely improved,” while changes in LBM and hand
grip strength were “unclear” or “trivial” in response to resistance exer-
cise training. The likelihood of improvement in MQI and STS was N 99%
and GUG and gait speed was N95%. Changes in grip strength and LBM
were primarily trivial (74.9 to 79.9%).
4. Discussion
In order to provide evidence-based support for the previously rec-
ommended muscle quality index, we primarily sought to determine
whether MQI changes in response to resistance exercise training
and detraining. Secondarily, we sought to determine how changes in
MQI compared to other recommended measures of physical function
(sit to stand, gait speed, and grip strength) and muscularity (lean
body mass) suggested by the proposed definitions of sarcopenia. Our
results show that MQI increases with resistance exercise training in
older adults to a greater magnitude and presents higher reliability
than other functional measures. Additionally, improvements were
maintained during the detraining period. These findings may have
future clinical implications for quantifying muscle function as a
symptom of sarcopenia during routine physical examinations.
Our main results show that muscle quality index (MQI), a clinical
assessment of physical function, increases with 6-weeks of resistance
exercise in older adults. This is the first investigation to our knowledge
to evaluate change in MQI to any intervention. As MQI measures the
force generating capacity of the knee extensor muscles (Takai et al.,
2009), we had expected to see improvements as a result of the training
program. The muscle groups responsible for leg extension were trained
with modified squat, split squat, and machine leg extension exercises
during the full body progressive exercise training regimen. As we previ-
ously reported, laboratory-based measures of leg extension strength
and relative strength significantly increased 32% and 31%, respectively,
from the implemented training regimen (Scanlon et al., 2013). The sen-
sitivity and reliability of the MQI to detect improvements, as shown in
the present study, highlight the potential clinical utility of this new
measure. As an elaborative clinical measure of the more common and
simple measure of timed sit to stand, MQI also incorporates the anthro-
pometric measures of body mass and leg length. Previously, body size
has been shown to alter the relationship between chair rise perfor-
mance and leg strength (Takai et al., 2009). MQI incorporates body di-
mensions in its computation; therefore, it may be a more informative
measure despite the diversity of body size observed in human popula-
tions. Although, no significant body mass or composition changes
were detected in the present study, inclusion of anthropometrics
makes MQI a comparative relative measure among individuals of vary-
ing body sizes, especially men and women. While the present study
included both men and women to maximize the potential generalizabil-
ity of the findings and was not statistically powered to run analyses by
gender, gender is an important consideration in interpreting responses
to interventions for sarcopenia.
The observed magnitude of change in MQI was greater than other
measures of physical function (e.g. gait speed, grip strength, timed
chair rise, get-up and go) or muscle status (e.g. lean body mass). As it
is ideal for functional measures of muscular status to be both specific
to measure relevant characteristics and sensitive to respond to directed
intervention, our preliminary results support the MQI measure to be
further evaluated. While measures of gait speed, grip strength, and
 M.S. Fragala et al. / Experimental Gerontology 53 (2014) 1–6 5

Table 2
Changes in measures of physical function observed from during Phase 1 and Phase 2.

Baseline Phase 1 Phase 2

Muscle quality index (W) Group 1 199.06 ±69.14 242.88 ±97.13# 245.58 ±100.87⁎
Group 2 199.59 ±80.71 208.18 ±61.58⁎ 244.99 ±75.38 #
Hand grip strength (kg) Group 1 36.25 ±10.94 39.17 ±13.58 # 40.08 ±15.72
Group 2 32.82 14.17 34.18 ±16.48 35.55 ±15.71 #
Gait time (s) Group 1 1.92 ±0.44 1.64 ±0.28 # 1.70 ±0.34⁎
Group 2 1.75 ±0.41 1.77 ±0.24⁎ 1.68 ±0.27
Sit-to-stand (S) Group 1 14.19 ±2.84 11.57 ±1.66# 11.39 ±1.77⁎
Group 2 12.92 ±2.17 12.14 ±1.61⁎ 10.48 ±1.35 #
Get-up and go (s) Group 1 8.67 ±2.57^ 7.52 ±1.28 # 7.16 ±1.29
Group 2 8.41 ±0.86 7.79 ±0.94 7.12 ±0.79 #
Lean body mass (kg) Group 1 47.70 ±10.67 47.92 ±10.51 49.19 ±10.88
Group 2 49.58 ±13.48 49.51 ±13.23 48.97 ±12.84
^
p = 0.042 between groups at baseline.
#
p b 0.10 from previous time-point.
⁎p b 0.10 for interaction between groups at specified time-point.
Group 1 exercised during Phase 1 and detrained during Phase 2.
Group 2 completed the control condition during Phase 1 and exercised during Phase 2.

Table 3
Changes in functional measures pre- and post-training.

Percent

Measure n Pre Post p Difference Pos Triv Neg

Muscle quality index (W) 23 203.43 ± 64.31 244.25 ± 82.92 0.000 41 ± 19 99.7 0.3 0.0
Hand grip strength (kg) 23 35.26 ± 13.58 37.43 ± 14.42 0.010 2.2 ± 1.6 25.1 74.9 0.0
Sit-to-stand (s) 23 13.21 ± 2.51 11.05 ± 1.58 0.000 −2.2 ± 0.93 0.0 0.0 100.0†
Gait time (s) 23 1.85 ± 0.36 1.66 ± 0.27 0.005 −0.19 ± 0.13 0.0 4.9 95.1†
Get-up and go (s) 23 8.25 ± 1.98 7.33 ± 1.07 0.002 −0.92 ± 0.57 0.0 3.7 96.3†
Lean body mass (kg) 23 48.4 ± 11.91 48.7 ± 11.54 0.869 0.3 ± 3.6 12.8 79.9 7.3

n = sample size; Pre = pre-training; Post = post-training; p = significance; Pre and Post values presented as mean ± SD. Difference values presented as mean ±90% confidence intervals.
Pos = % positive change; Triv = % trivial change; Neg = % negative change. †Note for timed tests of STS, Gait, and GUG a reduction in time (s) corresponds to improved performance.

lean body mass are evidence-based measures from cross-sectional and
longitudinal studies, their sensitivities to detect improvements to inter-
ventions require further evaluation. The establishment of specific and
sensitive functional measures for sarcopenia is needed for future clinical
trials of pharmaceutical interventions. As a first step to compare chang-
es among measures, MQI may provide new additive information to the
more commonly accepted measures. MQI provides a clinical estimate of
lower body muscular power, which previous studies have shown is
more adversely affected by aging and sarcopenia (Frontera et al.,
1991; Goodpaster et al., 2006; Hakkinen et al., 1996). Additionally, the
ability to generate muscle power of the lower body is involved in
many tasks of daily living like climbing stairs or rising from bed and
was recently recommended as the best measure of muscle quality
(Barbat-Artigas et al., 2012). Thus, in comparison to other common
measures of muscle status, MQI is a clinically feasible muscle specific
measure of power.
Six weeks of detraining did not result in significant losses in the
improvement that were attained during the training regimen in any
variable. Similarly, Henwood and Taaffe (Henwood and Taaffe, 2008)
previously reported that older adults were able to maintain functional
benefits and improvements in strength and power after detraining.
Although a positive finding, the preservation of improvements after
6-weeks of cessation of training was contrary to our initial hypothesis.
We had expected to see some decrements in functional performance
in the follow-up measure. However, results could be explained by
daily activities in the “de training” period. Our “de training” period
only involved the cessation of resistance exercise training for 6-weeks
with instructions to maintain normal daily activities. It is possible that
the initial 6-week training period resulted in increases in functional
capacities that inherently increased daily activities during the detraining
period—a variable not measured in the present study. Nevertheless, the
observed functional maintenance in the current and prior investigations
has important translational relevance to daily activities in older adults.
5. Conclusion
In conclusion, MQI significantly changes in response to short term
resistance exercise training to a clinically meaningful magnitude in
older adults. Improvements in MQI exceeded those of other measures
of muscular function and status. Additionally, because MQI is based on
the timed sit to stand test, it has high potential clinical applicability.
Thus, the feasibility, sensitivity and reliability of MQI assessment make
it an informative and potentially useful tool for clinical and interven-
tional assessments of the functional status associated with sarcopenia.
Future studies should further evaluate this measure with others in addi-
tional interventional trials. Interestingly, no performance decrements
were observed in 6-weeks of detraining in older adults. Thus, functional
improvements attained from short term resistance training can poten-
tially be sustained for up to 6-weeks following cessation. Future studies
are needed to determine if the results are due to residual adaptations or
increased functional capacities translated to daily living.
Conflict of interest
Authors have no financial or personal conflicts of interest to report
which may be perceived to influence the results.
Acknowledgments
This research was supported by the Learning Institute for the Elders,
the University's Office of Research, and the Toni Jennings Exceptional
Educational Institute.
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