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Influence of muscle mass in the assessment of lower limb strength in COPD: validation of the prediction equation
  1. Ruth Trethewey1,
  2. Dale Esliger1,2,
  3. Emily Petherick1,
  4. Rachael Evans1,3,4,
  5. Neil Greening3,5,
  6. Benjamin James5,
  7. Andrew Kingsnorth1,
  8. Mike Morgan3,
  9. Mark Orme1,
  10. Lauren Sherar1,
  11. Sally Singh1,4,
  12. Nicole Toms3,5,
  13. Michael Steiner1,4,5
  1. 1School of Sport, Exercise and Health Sciences, National Centre for Sport and Exercise Medicine, Loughborough University, Loughborough, UK
  2. 2NIHR Leicester Biomedical Research Centre – Lifestyle, Leicester, UK
  3. 3Respiratory Medicine, Glenfield Hospital, Leicester, UK
  4. 4Centre for Exercise and Rehabilitation Services, University Hospitals of Leicester NHS Trust, Leicester, UK
  5. 5NIHR Leicester Biomedical Research Centre – Respiratory, Leicester, UK
  1. Correspondence to Ruth Trethewey, National Centre for Sport and Exercise Medicine, School of Sport Exercise and Health Sciences, Loughborough LE11 3TU, UK; R.Pearson3{at}


Absence of established reference values limits application of quadriceps maximal voluntary contraction (QMVC) measurement. The impact of muscle mass inclusion in predictions is unclear. Prediction equations encompassing gender, age and size with (FFM+) and without (FFM−), derived in healthy adults (n=175), are presented and compared in two COPD cohorts recruited from primary care (COPD-PC, n=112) and a complex care COPD clinic (COPD-CC, n=189). Explained variance was comparable between the prediction models (R2: FFM+: 0.59, FFM−: 0.60) as were per cent predictions in COPD-PC (88.8%, 88.3%). However, fat-free mass inclusion reduced the prevalence of weakness in COPD, particularly in COPD-CC where 11.9% fewer were deemed weak.

  • Muscle strength
  • Chronic obstructive pulmonary disease
  • Quadriceps maximal voluntary contraction
  • Fat-free mass
  • Prediction equation
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  • Contributors RET and MCS developed the concept of the study and wrote the manuscript. Others contributed to the final version. RET, ESP, DWE, NJG and MCS were involved in the study design and data analysis. BDJ made additional contributions to the data analysis. DWE, RAE, NJG, AK, MWO, LBS, SJS, MCS and NT were also involved in the data acquisition and all authors have provided approval of the final version to be published.

  • Competing interests None declared.

  • Ethics approval The cohorts studied had the relevent NHS REC approvals: 13-EM-0389, 13/EM/0287.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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