Measuring skeletal muscle strength and endurance, from bench to bedside

Peripheral muscle dysfunction is a recognized and important systemic consequence of many chronic diseases. Peripheral muscle weakness is associated with excess utilization of health care recourses, morbidity and /or mortality in patients with COPD, congestive heart failure, liver and frail elderly. In the latter group, muscle weakness was associated with significant increase in falling and falling related injury. Exercise training does enhance skeletal muscle function and exercise performance. In addition, patients who start a training program with impaired skeletal muscle function may be more likely to respond adequately to an exercise training program. It is beyond the scope of the present review to discuss in detail the factors that may contribute to muscle dysfunction in chronic conditions. Clearly, muscle weakness is multi-factorial. Factors associated with skeletal muscle force are general factors (such as age, body weight, sex), disease related factors (such as inactivity) and disease specific factors (for example in COPD drug treatment, i.e. corticosteroid treatment, inflammation, oxidative stress and hypoxia have been shown to contribute to muscle dysfunction). This review will focus on the different ways to assess skeletal muscle function in patients with chronic disease. More specifically, techniques to assess skeletal muscle strength, skeletal muscle endurance and skeletal muscle fatigue will be discussed. For the American College of Sport Medicine (ACSM) not only muscle strength but also muscle endurance are health- related fitness components. Loss in one of these muscle characteristics results in impaired muscle. Muscle function tests are very specific to the muscle group tested, the type of contraction, the velocity of muscle motion, the type of equipment and the joint range of motion. Results of any test are specific to the procedures used. Individuals should participate in familiarization sessions with the equipment, and adhere to a specific protocol in order to obtain a true and reliable score. A change in one’s muscular fitness over time can be based on the absolute value of the external force (Newton (N)), but when comparisons are made between individuals, the values should be expressed as relative values (percentage of a predicted normal value). In both cases, caution must be taken in the interpretation of the result because the norms may not include a representative sample of the individual being measured, a standardized protocol may be absent, or the exact test being used may differ