European Journal of Applied Physiology (2023) 123:1299–1309

https://doi.org/10.1007/s00421-023-05156-w

ORIGINAL ARTICLE

Hip flexion angle affects longitudinal muscle activity of the rectus

femoris in leg extension exercise
Hiroku Mitsuya1 · Koichi Nakazato1 · Takayoshi Hakkaku1 · Takashi Okada1

Received: 21 October 2022 / Accepted: 8 February 2023 / Published online: 16 February 2023
© The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature 2023

Abstract
Purpose We investigated the effect of the hip flexion angle (HFA) on the longitudinal muscle activity of the rectus femoris
(RF) during leg extension exercise (LEE).
Methods We conducted an acute study in a specific population. Nine male bodybuilders performed isotonic LEE using a leg
extension machine at three different HFAs: 0°, 40°, and 80°. Participants extended their knees from 90° to 0° at each HFA
setting for four sets of ten repetitions at 70% of the one-repetition maximum. The transverse relaxation time (T2) of the RF
was measured before and after LEE using magnetic resonance imaging. We analyzed the rate of change in the T2 value in
the proximal, middle, and distal regions of the RF. The subjective sensation of muscle contraction of the quadriceps was
measured using a numerical rating scale (NRS) and compared with the T2 value which was the objective index.
Results At 80°, the T2 value in the middle RF was lower than that in the distal RF (p < 0.05). The T2 values at 0° and 40°
HFA were higher than those at 80° HFA in the proximal (p < 0.05, p < 0.01) and middle RF (p < 0.01, p < 0.01). The NRS
scores were inconsistent with the objective index.
Conclusion These results suggest that the 40° HFA is practical for region-specific strengthening of the proximal RF, and
subjective sensation alone as an indication of training may not activate the proximal RF. We conclude that activation of each
longitudinal section of the RF is possible depending on the hip joint angle.

Keywords Resistance training · Magnetic resonance imaging · T2 value · Bodybuilding

Abbreviations Introduction
1RM One repetition maximum
ANOVA Analysis of variance The rectus femoris (RF) is the only biarticular muscle of
EMG Electromyography the quadriceps femoris vital for bipedal walking (Kernozek
HFA Hip flexion angle 1993). There have been many reports on the RF functional
LEE Leg extension exercise characteristics related to running mechanics and heteroge-
MRI Magnetic resonance imaging neous neuromuscular activation during walking (Ema et al.
NRS Numerical rating scale 2018; Watanabe et al. 2014b). In particular, the proximal RF
RF Rectus femoris is recruited during the early swing phase of walking (Wata-
T2 value Transverse relaxation time nabe et al. 2014b) and hip flexion motion (Watanabe et al.
VI Vastus intermedius 2012). However, this role of the proximal RF may cause falls
VL Vastus lateralis because specific proximal RF recruitment has not been con-
VM Vastus medialis firmed in the elderly (Watanabe et al. 2018). Strengthening
the proximal RF is vital to enhance sprint and kicking per-
formance and prevent disabilities in athletes (Mendiguchia
Communicated by William J. Kraemer. et al. 2013). Moreover, hypertrophy of the proximal RF is
important for the bodybuilders who are the subjects of this
* Hiroku Mitsuya
20pda07@nittai.ac.jp study. Although there are many benefits of strengthening the
proximal RF, the muscle activity of the RF, especially for
1
Graduate School of Health and Sport Science, Nippon Sport longitudinal recruitment, remains unclear.
Science University, 7‑1‑1 Fukasawa, Setagaya‑ku, Tokyo,
Japan

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Many exercises are available for strengthening the quadri-
ceps femoris muscles. The leg extension exercise (LEE) is
the most popular single-joint exercise for the quadriceps
femoris. Previous studies have reported that LEE is better
than multi-joint exercises, such as leg press and squat, in
inducing muscle activity and hypertrophy of the RF (Earp
et al. 2015; Enocson et al. 2005; Mangine et al. 2018). From
these reports, LEE recruited the RF more than the vastus
lateralis (VL), vastus intermedius (VI), and vastus medialis
(VM). However, although LEE significantly increased the
muscle mass of the distal RF, the increase in the proximal
RF was smaller than that in the distal RF (Narici et al. 1996;
Wakahara et al. 2017). Thus, it is challenging to induce prox-
imal RF hypertrophy using popular lower limb exercises.
In previous studies (Narici et al. 1996; Wakahara et al.
2017), LEE was performed at a hip flexion angle (HFA) of
approximately 80°. However, changing the HFAs may affect
the longitudinal recruitment of the RF, particularly the prox-
imal RF, because the RF is a biarticular muscle related to the
knee and hip joints. In addition, the proximal tendon of the
RF is divided into two origins: the direct and indirect heads
(Gyftopoulos et al. 2008; Hasselman et al. 1995). Because
of the different attachment angles of these two tendons to the
pelvis, proximal RF activity may be influenced by changing
HFAs. Moreover, the proximal RF is specifically recruited
in the swinging motion of the leg, starting from the extended
position around the 0° HFA; this phenomenon disappears
in the flexed position during gait (Watanabe et al. 2014b).
The present study aimed to investigate the longitudinal
muscle activity of the RF and develop new exercises to acti-
vate the proximal RF. We hypothesized that changing the
HFA would change the RF length and the two head states
of the proximal RF and affect activity dynamics, especially
at the hip extension, which would recruit the proximal RF,
which is difficult to mobilize at an 80° HFA. We used the
transverse relaxation time (T2 value) measured with mag-
netic resonance imaging (MRI) to measure acute muscle
activation because surface electromyography (EMG) is
challenging due to the subcutaneous muscle slide. In par-
ticular, we used an isotonic LEE, which can reproduce actual
strength-training situations with different HFAs. In addition,
we examined the relationship between objective muscle
activity and the subjective sensation of muscle contraction
of the RF to provide further insight for application in actual
Fig. 1  Schematic illustrations of
the leg extension exercise. The
unilateral leg extension exercise
that extends the knee joint from
90° flexion to 0° was performed
with a randomly selected leg.
The hip flexion angles were set
to 0°, 40°, and 80°
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European Journal of Applied Physiology (2023) 123:1299–1309
strength training situations without objective muscle activ-
ity parameters. These results will be useful in establishing a
novel regimen for recruiting the proximal RF.
Methods
Participants
Approval was obtained from the university's ethics commit-
tee (021-H211; date of approval: January 31, 2022), and the
study conformed to the tenets of the Declaration of Helsinki
(Rickham 1964). All participants provided written informed
consent before participating in the study. In addition, we
informed all the participants and their coaches about the
purpose and potential risks of this study. Nine male body-
builders with a training history averaging over 5 years
(age: 20.3 ± 1.4 years, height: 171.7 ± 4.4 cm, weight:
77.6 ± 9.9 kg, bodybuilding training career: 5.4 ± 2.2 years)
and no history of thigh and knee injuries participated in this
experiment. The participants had been training for muscle
hypertrophy for more than 2 years, and were still undergoing
a programmed high-intensity strength training routine for
approximately one–three hours per day, at least four times
per week. The self-reported one-repetition maximum (1RM)
of the barbell squat was 165.56 ± 36.52 kg, indicating a high
strength level.
Procedures
The unilateral LEE that extends the knee joint from 90° flex-
ion to 0° was performed with a randomly selected leg using
a LEE machine named the leg-developer machine (CLC-
385, Tuff Stuff Fitness, Chino, California, USA). Because
the HFA could not be changed on a regular weight-stacked
machine, we used a leveraged leg developer machine that
was attached to an adjustable bench and allowed the HFA
to be adjusted. The HFAs were set as 0°, 40°, and 80°. An
angle of 80° was defined as the conventional LEE angle, 0°
was the angle at which the hip could be mechanically fully
extended, and 40° was the HFA angle between them (Fig. 1).
A rubber band was attached so that the participant's lower
leg touched the band at the position where the knee joint
was extended to 0° to confirm full extension of the knee
European Journal of Applied Physiology (2023) 123:1299–1309
joint. The hip joint was fixed to the machine with a stiff band
so that the posture would not collapse during exercise. The
schedule of measurements is shown in Fig. 2. At least 3 days
prior to exercise, 1RM of each HFA was measured, and 1RM
measurements of each HFA were taken at least 72 h apart.
LEE was performed in four sets of ten reps at 70%1RM load
corresponding to each HFA and rest for one minute between
sets. The order of the measurement conditions for the HFA
was randomly selected. LEE was performed on randomly
selected HFAs, and LEE on the next HFA were performed
at least 72 h later. In addition, the measurement schedule did
not overlap with the participants’ daily leg exercises.
The T2 values before and after exercise were measured
using MRI (ECHELON OVAL; 1.5 T, Hitachi Medical Sys-
tems, Tokyo, Japan). To exclude fluctuations in T2 values
due to diurnal changes, the participants rested in the supine
position for at least 30 min after arrival in the laboratory.
The measurements were performed around noon, with no
other exercises on the day of measurement. Because the LEE
protocol was performed in the front room of the MRI, the
MRI scan was started within one minute from the end of
LEE. The scan was completed within 15 min with a pro-
tocol that could scan the entire thigh in one shot in a rest-
ing supine position (TE:25, 50, 75, 100 ms; TR:5000 ms;
matrix:512 × 320; field of view:40 cm; mulch slices:25
slices; slice thickness:1 cm; gap:1 cm). The 50% point of
the line connecting the femur greater trochanter and lateral
epicondyle (the center point of the femur) was marked with
a permanent pen and overlapped with the laser pointer show-
ing the center of the image irradiated from the MRI. This
point was the center of the slice image used to define the
slice position, and the 13th slice (the center of all 25 slices)
was synchronized with the center point of the femur.
Evaluation of the subjective sensation of muscle
contraction
RF, VL, and VM without VI were targeted for the subjective
sensation of muscle contraction because VI is located deeply
and is challenging to identify for participants. We used a
numeric rating scale (NRS) to index the subjective sensa-
tion of contraction of the quadriceps femoris muscle. NRS
was defined as zero to ten (ten being “the easiest of applying
Fig. 2  The schedule for the measurements. At least 3 days prior to
exercise, 1RM was measured at each HFA and 1RM measurements
of each HFA were taken at least 72 h apart. The HFAs were measured
in a randomly selected order. The LEE was performed at a randomly
1301
force,” 0 being “the most difficult of applying force”) by
applying the method of Holden et al. (2020). The RF was
divided into proximal, middle, and distal parts. The VL was
divided adjacent to the middle RF as the proximal VL, and
adjacent to the distal RF as the distal VL. However, the VM
was not divided into any regions because of its short length.
The NRS scores for each region were verbally assessed after
LEE at each angle.
Data analysis
The T2 value was calculated using analysis software (AZE
Virtual Place AVP-001A, Canon, Tokyo, Japan). After
superimposing the images of the four TEs using the soft-
ware, the outlines of the quadriceps were traced to determine
the regions of interest in each image. The T2 value of each
pixel was calculated using the software, and its T2 value
was measured in each slice. For the T2 values after LEE,
pixels that were + 1 standard deviation (SD) higher than the
mean T2 values before LEE were considered activated by
exercise and were used for calculation (Adams et al., 1993).
The difference in T2 value before and after LEE was calcu-
lated as the rate of change. From the images of all 25 slices,
ten slices in which the RF was stably confirmed were used
to analyze the T2 value. Image calculations were performed
twice for each slice, and the average value was used as the
T2 value. The coefficient of variation (CV) of the two meas-
urements for the region of interest was 0.45 ± 0.40%. The
intraclass correlation coefficient (ICC (1.2)) of the meas-
urements was 0.993. The above ten slices were divided into
three proximal, four middle, and three distal slices. The aver-
age rate of change in the T2 values before and after LEE in
each slice group was calculated. We defined each slice group
as proximal, middle, and distal thigh regions. The proximal
thigh region includes the proximal radiofrequency (RF). The
middle thigh region includes the middle RF, proximal VL,
and proximal VI. The distal thigh regions include the distal
RF, distal VL, distal VI, and VM. We then compared the
rate of change in the T2 values of all muscles. In addition,
we compared the NRS scores for each muscle. Compari-
sons between each HFA within the same thigh region were
made to determine the LEE at which the HFA was best for
each region. Moreover, each thigh region within the same
selected HFA, and the LEE for the next HFA was performed at least
72 h later. The measurement schedule did not overlap with the par-
ticipant's daily leg exercises. 1RM = 1-repetition maximum. HFA hip
flexion angle, LEE leg extension exercise
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HFA was compared to observe the effect on the long axis
in the RF when LEE was performed under the same HFA
conditions.
Statistical analysis
All data are expressed as mean ± SD. The 1RM was com-
pared between HFAs using one-way analysis of variance
(ANOVA) with HFAs and thigh regions as factors. We
analyzed the rate of change in the T2 value between each
thigh region within the same HFA, and between each HFA
within the same thigh region. Comparisons of T2 values
between the RF and vastus muscle groups were performed
using a one-way ANOVA. As with the T2 value, the NRS
was analyzed using one-way ANOVA for each region and
HFA. Comparisons of the NRS scores between the RF and
vastus muscle groups were performed using the paired t-test
or one-way ANOVA. When the main effect was detected, a
one-way ANOVA followed by Bonferroni’s post hoc test
was performed for significant differences. The effect sizes
of the one-way ANOVA and t-test are shown by partial η2
and r, respectively. All tests were performed using statistical
analysis software SPSS Statistics Ver 27.0.0.1 for Windows
(IBM, Armonk, NY, USA). The significance level was set
at p < 5%.
One repetition maximum
We first confirmed a change in 1RM dependent on HFA
angles. The results showed that the 1RM was not sig-
nificantly different between each HFA (p = 0.240, partial
η2 = 0.127, Table 1), indicating that the change in 1RM
matched conventional angle-torque relationships.
Evaluation of objective muscle activity
The T2 values for each HFA and region are listed in Table 2.
Below is a comparison of each HFA and region.
T2 value comparisons of the RF and vastus muscle
group
LEE is a frequently used exercise regimen for training the
RF. To validate the T2 values as muscle activation indica-
tors, we compared the T2 values of different quadriceps
muscle groups, such as the RF, VL, and VI.
In the middle thigh region, we compared the middle RF,
proximal VL, and proximal VI because the VL, VM, and
VI were not in the proximal RF region. One-way ANOVA
confirmed the main effect at 40° HFA (p < 0.000, partial

Table 1  LEE 1RM at each HFA

Results HFA
0° 40° 80°
Representative images of the proximal (7th slice of 25), mid-
dle (13th slice, the center slice of the femur), and distal (16th 1RM (kg) 21.9 ± 4.0 25.0 ± 5.3 20.5 ± 6.4
slice of 25) regions are shown in Fig. 3. The dotted black LEE leg extension exercise, HFA hip flexion angle, RM repetition
line indicates the border of the quadriceps femoris. maximum. Values are expressed as mean ± SD

Fig. 3  Example of T2 MRI at

the proximal (7th slice of 25),
middle (13th slice of the center
of the femur), and distal (16th
slice of 25) regions of RF before
and after the LEE at 0° HFA.
The black dotted line indicates
the border of the quadriceps
femoris. The brighter the color,
the higher the T2 value. This
image is the 25 ms image of
the four TRs (25, 50, 75 and
100 ms). RF rectus femoris, VL
vastus lateralis, VI vastus inter-
medialis, VM vastus medialis

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η2 = 0.165) and 80° HFA (p = 0.004, partial η2 = 0.116).
At 40° HFA, RF was higher than VL (p < 0.000, r = 0.435,
Fig. 4B) and VI (p = 0.013, r = 0.349, Fig. 4B). At 80°
HFA, RF was lower than VL (p = 0.003, r = 0.439, Fig. 4C).
There was no significant difference in the muscles at 0° HFA
(p = 0.114, partial η2 = 0.052, Fig. 4A).
In the distal thigh region, we compared the distal RF,
VL, VI, and VM. The main effect was confirmed at an HFA
of 40° (p < 0.000, partial η2 = 0.146). At 40° HFA, RF was
higher than VL (p < 0.000, r = 0.487, Fig. 5B), VI (p = 0.001,
r = 0.462, Fig. 5B) and VM (p = 0.001, r = 0.376, Fig. 5B).
There was no significant difference in the muscles at 0°
HFA (p = 0.399, partial η2 = 0.021, Fig. 5A) or 80° HFA
(p = 0.412, partial η2 = 0.020, Fig. 5C).
Overall, the results suggest that the RF was recruited dur-
ing LEE independent of the HFA, as we anticipated.
T2 value comparisons between each HFA
within the same region
The primary aim of this study was to examine whether
the T2 values of different regions in the same RF were
changed by the HFA. For this purpose, we first exam-
ined whether T2 values were affected by HFA. The main
effect was confirmed at the proximal RF (p = 0.001, partial
η2 = 0.247) and middle RF (p = 0.001, partial η2 = 0.267).
The proximal RF was lower at the 80° HFA than at the
0° HFA (p = 0.046, r = 0.413; Fig. 6A) and 40° HFA
(p = 0.001, r = 0.566; Fig. 6A). The middle RF was lower
at the 80° HFA than at the 0° HFA (p = 0.007, r = 0.474;
Fig. 6B) and 40° HFA (p < 0.001, r = 0.583; Fig. 6B).
There was no significant difference in the distal RF at any
HFA (p = 0.108, partial η2 = 0.079, Fig. 6C). These results

Table 2  T2 value for each HFA and thigh region

Rectus femoris Vastus lateralis Vastus intermedius Vastus medialis
Hip flexion Proximal Middle Distal Proximal Distal Proximal Distal
angle

0° 43.6 ± 18.2 45.2 ± 17.9 43.4 ± 23.1 37.0 ± 15.1 36.9 ± 14.8 38.4 ± 9.2 36.7 ± 8.2 38.6 ± 11.8
40° 55.0 ± 20.3 53.8 ± 18.7 52.7 ± 20.5 35.2 ± 14.4 34.3 ± 14.7 39.2 ± 10.9 37.6 ± 10.7 39.1 ± 13.7
80° 28.6 ± 12.6 30.3 ± 10.4 40.8 ± 19.1 40.9 ± 11.7 41.3 ± 12.3 36.3 ± 13.8 37.1 ± 11.3 42.0 ± 13.5

T2 Transverse relaxation time, HFA hip flexion angle. Values are expressed as mean ± SD

Fig. 4  Comparison of the rate

of change of T2 between RF
and vastus muscle group in the
middle region of the RF. A 0°
HFA. B 40° HFA. C 80° HFA.
RF rectus femoris, VL vastus
lateralis, VI vastus interme-
dius, HFA hip flexion angle.
*p < 0.05, **p < 0.01

Fig. 5  Comparison of the rate

of change of T2 between RF
and vastus muscle group in the
distal region of the RF. A 0°
HFA. B 40° HFA. C 80° HFA.
RF rectus femoris, VL vastus
lateralis, VI vastus intermedius,
VM vastus medialis, HFA hip
flexion angle. **p < 0.01

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suggest that the proximal and middle RF are activated by Evaluation of the subjective sensation of muscle
the hip joint extension. contraction

T2 value comparisons between each region
within the same HFA
Next, we compared the T2 changes in the proximal, middle,
and distal RF regions after LEE using the same HFA. The
main effect was confirmed at 80° HFA (p = 0.024, partial
η2 = 0.105). The distal RF was higher than the middle RF
(p = 0.023, r = 0.333; Fig. 7C). There was no significant
difference among the muscles at 0° HFA (p = 0.957, par-
tial η2 = 0.002, Fig. 7A) and 40° HFA (p = 0.878, partial
η2 = 0.004, Fig. 7B). Although the results showed that the
distal RF was highly activated at the 80° HFA, we postulated
that areas other than the distal RF were weakly recruited at
the extended position.
The NRS scores for each HFA and region are presented in
Table 3. Below is a comparison of each HFA and region.
NRS comparisons of the RF and vastus muscle group
The subjective sensation of muscle contraction is commonly
used to strengthen the quadriceps in an actual strength-
training situation. To compare the subjective sensation
of muscle contraction with the T2 value as the objective
measure of muscle activity, we examined the NRS score of
the quadriceps. In the middle thigh region, there were no
significant differences between the RF and VL at 0° HFA
(p = 0.161, r = 0.479), 40° HFA (p = 0.062, r = 0.609), and
80° HFA (p = 0.214, r = 0.403). Furthermore, in the distal
thigh region, there were no significant differences in the RF,

Fig. 6  Comparison of the rate

of change of T2 between each
HFA within the same region. A
Pro RF = proximal rectus femo-
ris. B Mid RF = middle rectus
femoris. C Dis RF = distal
rectus femoris. HFA hip flexion
angle. *p < 0.05, **p < 0.01

Fig. 7  Comparison of the rate

of change of T2 between each
region within the same hip
flexion angle. A 0° HFA. B 40°
HFA. C 80° HFA. HFA hip
flexion angle, Pro RF proximal
rectus femoris, Mid RF middle
rectus femoris, Dis RF distal
rectus femoris. *p < 0.05

Table 3  NRS for each HFA and Rectus femoris Vastus lateralis Vastus medialis
region
Hip flexion Proximal Middle Distal Proximal Distal
angle

0° 4.7 ± 1.1 6.6 ± 2.3 7.2 ± 2.4 4.8 ± 3.0 6.2 ± 3.7 7.7 ± 2.4
40° 5.9 ± 2.3 7.6 ± 2.4 7.6 ± 1.5 5.3 ± 2.2 6.4 ± 2.5 8.3 ± 2.0
80° 3.1 ± 2.4 4.7 ± 2.8 7.3 ± 2.5 5.8 ± 2.8 7.4 ± 1.5 8.6 ± 1.1

NRS numeric rating scale, HFA hip flexion angle. Values are expressed as mean ± SD

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VL, and VM at 0° HFA (p = 0.560, partial η2 = 0.047), 40°
HFA (p = 0.160, partial η2 = 0.141), and 80° HFA (p = 0.311,
partial η2 = 0.093). It is difficult to be aware of the differ-
ences in subjective muscle contraction within the quadriceps
because the objective muscle activity results showed higher
T2 values in the RF than in the vastus muscle group, but no
difference was observed in the NRS.
NRS comparisons between each HFA
within the same thigh region
The secondary aim of this study was to compare objective
muscle activity and subjective sensation of muscle contrac-
tion. Therefore, we examined whether the NRS score of the
RF was affected by HFA. A one-way ANOVA confirmed the
main effect at the proximal RF (p = 0.026, partial η2 = 0.263).
The hip flexion at 80° was lower than that at 40° (P = 0.023,
r = 0.532; Fig. 8A). There was no significant difference in
the middle (p = 0.062, partial η2 = 0.207, Fig. 8B) and dis-
tal RF (p = 0.948, partial η2 = 0.004, Fig. 8C). These results
suggested that the T2 values and NRS coincided only when
the HFA was 40°.
NRS comparisons between each region
within the same HFA
Next, we compared the NRS scores of the proximal, mid-
dle, and distal RF regions after LEE using the same HFA.
The main effect was confirmed at 0° HFA (p = 0.035, par-
tial η2 = 0.244) and 80° HFA (p = 0.007, partial η2 = 0.338).
The NRS score in the distal RF was higher than that in the
proximal RF at 0° HFA (p = 0.039, r = 0.588; Fig. 9A) and
80° HFA (p = 0.006, r = 0.669; Fig. 9C). There was no sig-
nificant difference in NRS at 40° HFA (p = 0.166, partial
η2 = 0.139, Fig. 9B). Since the results of the NRS and the
rate of change of T2 values did not coincide, we suggest that
there is a discrepancy between the subjective sensation of
muscle contraction and objective muscle activity. Through-
out the results, the NRS and T2 value results were consistent
only for the 40° HFA. Overall, the results suggested that the
NRS, as the subjective sensation of muscle contraction, was
inconsistent with the rate of change of the T2 value as the
objective muscle activity.
Discussion

This study aimed to investigate the longitudinal muscle

activity of the RF, particularly in the LEE, with differ-
ent HFAs. We compared LEE with extended HFAs and a

Fig. 8  Comparison of NRS

conditions between HFAs in the
same region. A Pro RF = proxi-
mal rectus femoris. B Mid
RF = middle rectus femoris. C
Dis RF = distal rectus femoris.
HFA hip flexion angle. *p < 0.05

Fig. 9  Comparison of NRS

conditions between regions at
the same HFA. A 0° HFA. B
40° HFA. C 80° HFA. Pro RF
proximal rectus femoris, Mid
RF middle rectus femoris, Dis
RF distal rectus femoris, HFA
hip flexion angle. *p < 0.05,
**p < 0.01

13
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conventional HFA close to the vertical using the T2 value
as the objective muscle activity and the NRS as the subjec-
tive sensation of muscle contraction. The RF is divided into
three regions: proximal, middle, and distal. We found that,
at 40° HFA, the T2 value of the RF was higher than that of
the vastus muscle group; however, at 80° HFA, the T2 value
of the RF was lower than that of the VL. Furthermore, LEE
at 0° and 40° HFA showed significantly higher T2 values in
the proximal and middle RF than at 80° HFA, similar to con-
ventional LEE. However, the subjective sensation of muscle
contraction in the proximal RF was not consistent with T2
values. Based on these results, the validity of region-specific
activation of the RF in LEE and its application in training
are discussed.
To strengthen the quadriceps, the recruitment rate of each
head of the quadriceps femoris muscle should be considered.
Therefore, this study aimed to investigate the effects of LEE
on the quadriceps. When the RF and vastus muscle groups
were compared, the T2 value of the RF was higher than that
of the vastus muscle group at an HFA of 40°, but lower than
that of the VL at an HFA of 80°. In addition, the T2 values
of the RF and vastus muscle groups increased similarly at
a 0° HFA. In previous studies by Wakanara et al. (2017)
and Narici et al. (1996), recruitment within the quadriceps
femoris was compared and the authors reported that RF
recruitment was higher than that of the vastus muscle group
in LEE. In contrast, RF recruitment has been reported to be
low and that of the vastus muscle group high during multi-
joint movements of the lower extremities (Earp et al. 2015;
Enocson et al. 2005; Mangine et al. 2018). This is related
to the presence or absence of torque exertion during hip
extension (Ema et al. 2016), like the results reported above
for LEE, which correspond to the single-joint motion in this
study. Because these studies were conducted with untrained
participants, the fact that the RF is more easily recruited
than the vastus muscle groups in LEE was not influenced by
training experience when compared with the present study.
However, the rate of increase in the volume of each muscle
and the EMG of only one point of the muscle were the only
judgments; therefore, detailed training effects on each region
were not detected. Furthermore, there are no reports compar-
ing muscle activity of the intra quadriceps femoris in LEE
at different HFAs; therefore, the present study provides new
insights into the quadriceps femoris.
In previous studies, the LEE was a conventional weight-
stack machine with an almost vertical seat angle at an HFA
of 80°. Therefore, with conventional LEE at an 80° HFA, it
is difficult to increase proximal and middle RF recruitment.
In other words, the RF cannot be activated entirely along the
longitudinal axis with conventional LEE. However, because
the RF is a biarticular muscle, it is affected by changes in the
HFA, which will affect muscle length changes in the LEE.
Therefore, it is necessary to consider LEE with hip extension
13
European Journal of Applied Physiology (2023) 123:1299–1309
instead of the conventional LEE with an HFA of 80° (Ema
et al. 2021). In a previous study, LEE was performed using a
leg-developer machine that could change the HFA. Previous
studies focusing on LEE by changing the HFA used isomet-
ric and eccentric contractions (Ema et al. 2021; Watanabe
et al. 2014a); however, the present study used isotonic con-
traction, which is easy to apply in actual strength training
situations. Because isotonic contractions do not use special
machines, they easily contribute to the primary prevention
of falls in the elderly and the prevention of disability in ath-
letes, not just in bodybuilders. This research question has not
been considered previously, and provides new insights into
LEE studies. Below, we discuss the effects of differences in
the HFA in the LEE on the RF.
We investigated the longitudinal activity of the RF mus-
cles. The LEE results at an 80° HFA, in which the distal RF
was much more activated than the proximal and middle RF,
were similar to those reported by Wakahara et al. (2017)
and Narici et al. (1996). In contrast, LEE at 0° and 40° HFA
in extension, compared with 80°, was able to recruit the
proximal and mid-RF. Moreover, the T2 value did not differ
significantly between the HFAs in the distal RF. This may
be because changing the HFA changed the length of the
RF and altered the dynamics of muscle activity. Maeo et al.
reported that elbow extension exercises at different shoulder
joint angles affected the hypertrophy of the triceps brachii
muscle (Maeo et al. 2022). They considered that differences
in muscle length affect muscle hypertrophy, and similar
results have been reported for hamstrings (Maeo et al. 2021).
Therefore, similar to the triceps brachii and hamstrings, the
present study may have affected the increase in proximal
RF activity owing to changes in RF length. LEE with hip
flexion of 0° and 40°, which is the stretching position of the
RF, could provide sufficient tension over the entire length
of the RF. Therefore, the LEE extending the HFA from 0°
to 40°can train the RF, including the proximal and middle
RF. Kodesho et al. (2021) measured the stiffness of the RF
muscle using shear wave elastography (SWE) when the knee
joint was passively flexed at a hip flexion angle of 0°. As
a result, the stiffness of the proximal RF was significantly
higher than that in the other regions. Because SWE is pro-
portional to the increase in EMG and torque (Nordez and
Hug 2010; Yoshitake et al. 2014) and is valid for skeletal
muscle evaluation (Eby et al. 2013), the study by Kodesho
et al. (2021) supports the specificity of the proximal RF.
This result suggests that changing the HFA may change the
tension of the proximal RF, particularly the longitudinal
muscular activity.
Conversely, some studies have investigated changes in the
HFA in LEE but involved isometric or eccentric exercises
(Ema et al. 2021; Watanabe et al. 2014a). Watanabe et al.
(2014a) reported that changing the HFA did not affect the
longitudinal muscular activity of the RF. However, in that
European Journal of Applied Physiology (2023) 123:1299–1309
study, isometric contractions were measured using surface
electromyography (EMG). Isometric measurements do not
correspond to actual strength training situations, and sur-
face EMG measurements may not be sufficient for the RF
because a subcutaneous muscle slide is induced by its long
length, even during isometric contraction. Therefore, subcu-
taneous muscle slides during isotonic exercises may make it
more challenging to measure muscle activity using EMG. In
such cases, the T2 value obtained using MRI can be a suit-
able measurement technique for objectively estimating mus-
cle activity (Wakahara et al. 2012, 2013, 2017). The ideal
method to measure the activity of biarticular muscles with
large subcutaneous displacement is to use T2 values, and
isotonics are suitable for easy application in actual strength
training situations. However, there are no reports using the
T2 value for the longitudinal activity of the RF in changing
the HFA. Moreover, no studies have performed LEE with
isotonic exercises suitable for actual strength training by
changing the HFA. Therefore, this is the first reported study
that measured the effect of LEE with different HFAs using
T2 values and provided new findings on longitudinal muscle
activity at the RF.
When training for hypertrophy, it is important not only
to perceive the efferent sensation of muscle contraction, but
also to be centripetally conscious of the target muscle that
is being recruited (Gandevia et al. 1992; Proske and Gan-
devia et al. 2009). However, fatigue has been reported to
disturb the perception of the sensation of muscle contrac-
tion (Fortier and Basset et al. 2012), and a discrepancy in
the perception between efferent sensations and centripetal
consciousness decreases muscle activity and hypertrophy
(Fujita et al. 2020; Paoli et al. 2019; Schoenfeld et al. 2018).
Therefore, the implementation of a training motion that is
less likely to impair the perception of muscle contraction in
a state of fatigue enhances the training effect. The present
study attempted to quantify the subjective sensation of mus-
cle contraction using the NRS to examine the relationship
between objective muscle activities. When comparing the
regions within the same HFA conditions between the T2
value and NRS, the NRS in the distal RF was consistent with
the T2 value at 80° HFA, but that at 0° and 40° were not.
In addition, when comparing HFAs within the same thigh
region in the proximal RF, the 40° HFA was consistent with
the T2 value and NRS results, but the 0° HFA was not. This
suggests that extending the HFA decreased the subjective
sensation of muscle contraction in the proximal RF.
As there have been no reports on the subjective sensa-
tion of muscle contraction during LEE, which is vital for
strengthening a particular muscle area of the RF in actual
strength training situations, the present study is the first to
report the relationship between T2 values and the sensation
of muscle contraction in the RF. From these results, LEE
at 40° HFA may be suitable for strengthening the proximal
1307
RF in actual strength-training situations because the NRS is
consistent with the T2 value. Moreover, this result indicates
that the sensation of muscle contraction and the T2 value did
not always coincide, even in trained participants; therefore,
strength training with only the subjective sensation of mus-
cle contraction to indicate RF activation may not guarantee
training effects. In other words, untrained subjects may have
an even lower sensation of muscle contraction, suggesting
that exercises at angles that match the target area and sensa-
tion are important. In the future, we would like to proceed
with a comparison of the NRS of untrained participants to
apply these principles to the general public.
The limitations of the present study are the evaluation
of the T2 value and that this was not a long-term interven-
tion study; however, it is expected that continuous LEE with
different HFAs in the present study will cause longitudinal
regional muscular hypertrophy of the RF. Previous studies
(Adams et al. 1992; Fisher et al. 1990; Vandenborne et al.
2000; Yue et al. 1994) demonstrated the validity of the T2
value for estimating muscle activity. Moreover, muscle
swelling is essential for muscle hypertrophy and an increase
in the T2 value, which estimates the change in water level,
leads to muscle hypertrophy (Hirono et al. 2022). There-
fore, we believe that increasing the T2 value is valuable for
muscular hypertrophy. The second limitation was the small
number of trained participants. This study measured the
acute muscle activity of the proximal RF in bodybuilders.
However, the subjective sensation of muscle contraction and
muscle activity dynamics among trained participants may be
higher than those of untrained participants.
While using trained participants is a limitation, by consid-
ering the NRS, we can investigate the differences in the sub-
jective sensation of muscle contraction between untrained
and trained participants. LEE with a 40° HFA may make
learning the sensation of proximal RF muscle contrac-
tion easier. Therefore, comparing advanced bodybuilders
with fine muscle control techniques with untrained people
and other athletes in various sports would be interesting.
In addition, the method used in this study for the NRS is
based on Holden et al. (2020) but the reproducibility of the
method has always been questionable. However, there is also
a review summarizing 54 reports on the NRS (Hjermstad
et al. 2010) which shows the validity and reproducibility of
the NRS. Further studies using the NRS with a variety of
participants are required in the future.
Conclusion
In conclusion, the T2 value of the RF was higher than that
of the vastus muscle group at an HFA of 40° but lower than
that of the VL at 80°. The distal RF showed no change in
muscle activity at any HFA during LEE, but the proximal
13
1308
and middle RF recruitment was lower at an 80° HFA. In
contrast, LEE enhanced the recruitment of the proximal and
middle RF by extending the HFAs from 0° to 40°. Moreover,
although at 40°, the increase in the subjective sensation of
muscle contraction coincided with the T2 value of the proxi-
mal RF, the subjective sensation of muscle contraction and
objective muscle activity do not always coincide. Therefore,
we conclude that it is possible to strengthen each longitudi-
nal section of the RF according to the hip joint angle. These
findings provide new insights into the longitudinal muscle
activity and LEE settings of the RF.
Acknowledgements The authors would like to thank the professors
who provided guidance for conducting this research.
Author contributions HM and TO conceived and designed the study.
HM conducted experiments and wrote the manuscript. TO, KN, and
TH revised and approved the manuscript. All the authors have read and
approved the final manuscript.
Data availability The data generated during the current study are avail-
able from the corresponding author on reasonable request.
Declarations
Conflict of interest This study did not receive any specific grants from
funding agencies in the public, commercial, or non-profit sectors. The
results of the current study do not constitute an endorsement of any
product by the authors.
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