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The purpose of this study was to identify causes of quadriceps muscle weakness in facioscapulohumeral muscular dystrophy (FSHD). To this aim, we evaluated quadriceps muscle and fat volumes by magnetic resonance imaging and their relationships with muscle strength and oxidative stress markers in adult patients with FSHD (n = 32) and healthy controls (n = 7), and the effect of antioxidant supplementation in 20 of the 32 patients with FSHD (n = 10 supplementation and n = 10 placebo) (NCT01596803). Compared with healthy controls, the dominant quadriceps strength and quality (muscle strength per unit of muscle volume) were decreased in patients with FSHD. In addition, fat volume was increased, without changes in total muscle volume. Moreover, in patients with FSHD, the lower strength of the non-dominant quadriceps was associated with lower muscle quality compared with the dominant muscle. Antioxidant supplementation significantly changed muscle and fat volumes in the non-dominant quadriceps, and muscle quality in the dominant quadriceps. This was associated with improved muscle strength (both quadriceps) and antioxidant response. These findings suggest that quadriceps muscle strength decline may not be simply explained by atrophy and may be influenced also by the muscle intrinsic characteristics. As FSHD is associated with increased oxidative stress, supplementation might reduce oxidative stress and increase antioxidant defenses, promoting changes in muscle function. [Display omitted] • In FSHD, reduced quadriceps muscle quality is associated with oxidative stress. • Muscle quality participates to the reduction of FSHD quadriceps strength. • FSHD quadriceps muscle quality is improved by antioxidant supplementation. • Antioxidant supplementation improves patient quality of life by increasing physical functioning. [ABSTRACT FROM AUTHOR]

Background: We investigated intramuscular fat (IMF) in quadriceps femoris (QF) and hamstring muscles in the middle-aged women with knee osteoarthritis (KOA). We also examined the relationship between muscular infiltration of QF and hamstring muscles and muscle architecture and physical performance of the women with KOA.Methods: In this cross-sectional study, 72 women were included. Body muscle and fat mass were measured by BIA, isometric muscle strength was evaluated by hand-held dynamometer. IMF and muscle architecture were calculated from rectus femoris (RF), vastus intermedius (VIM), vastus lateralis (VL), vastus medialis (VM), biceps femoris (BF), semitendinosus (ST) and semimembranosus (SM) using B-mode ultrasonography. KOA-related symptoms and functions were assessed with KOOS. The functional performance assessments were evaluated with Stair Climbing Test, 20-Meter Walking Test.Results: Women with KOA had more IMF in RF, VIM, VL, VM and BF, ST, SM muscles compared to the healthy women. Pennation angles decreased as the IMF in the RF, VM, BF and ST decreased. As the IMF of the RF and VM increased isometric knee extensor strength decreased and KOOS symptom score, pain score and ADL score increased in women with KOA. Walking and stair climbing speed deteriorated as the IMF in RF, VIM, VM, BF increased in the middle-aged women. As the IMF in BF increased isometric knee flexor strength decreased and KOOS scores increased. Physical performance scores deteriorated as the IMF in BF increased in middle-aged women with KOA.Conclusion: IMF in QF and hamstring muscles were higher in the middle-aged women with KOA group compared with that in the healthy group. Weakness of the QF and hamstring muscles may due to the changes in architectural properties of muscle depending on muscular infiltration. IMF in knee muscles is an important determining factor in performance and physical function of middle-aged women with KOA. [ABSTRACT FROM AUTHOR]

This study aimed to investigate the relationship between daytime sleepiness and mortality risk among older adults. The moderating effects of sex and physical function were examined. This 9-year follow-up study was conducted with community-dwelling individuals aged ≥65 years. Daytime sleepiness was evaluated using the Epworth Sleepiness Scale (ESS). Exploratory factor analysis (EFA) was used to examine the ESS factors. Handgrip strength was measured to assess physical function, and the highest quartile was defined as good muscle power. Cox regression analysis was used to estimate the 9-year all-cause mortality risk. The interaction terms were examined to evaluate their moderating effect. In total, 2588 individuals participated in the study. The EFA explored two factors: the passive factor (PF) and the active factor (AF). After controlling for various covariates, the cutoff-defined daytime sleepiness (ESS≥11), total raw scores, and factor scores of the ESS all failed to predict mortality risk. The 3-way interaction terms showed statistical significance in terms of [sex × PF × muscle power (p = 0.03)] but not for [sex × AF × muscle power (p = 0.11)]. Specifically, PF predicted mortality risk in women with good muscle power (hazard ratio (HR): 1.48; 95 % confidence interval (CI): 1.04–2.10), which is female-specific. In contrast, AF predicted mortality risk only in men with good muscle power (HR: 1.35; 95 % CI: 1.02–1.78). The ESS-measured daytime sleepiness in older adults is multidimensional. The mortality risk for each dimension was determined based on sex and physical function. • The Epworth Sleepiness Scale (ESS) had dual construct in older adults. • Sex- and muscle power modified mortality risk conferred from daytime sleepiness. • Dimensions of the ESS conferred sex-specific mortality risk. [ABSTRACT FROM AUTHOR]

Obstructive sleep apnea (OSA) is a frequently observed and remarkably incapacitating disorder worldwide. As a multisystem disorder, OSA has been linked to a plethora of clinical parameters though physical parameters like muscle strength have been scantily studied. Hand grip strength (HGS) is a practical marker of physical function that has been associated with mortality and an array of clinical outcomes as well as physiological parameters like sleep duration. A few seminal studies have observed no link between HGS and OSA severity while no studies evaluated the relationship between objectively determined sleep duration and HGS in OSA. The present study aimed to evaluate the HGS indices among both OSA severity groups and objectively determined sleep duration groups in OSA. 111 treatment-naïve mostly middle-aged individuals with OSA (86 males) were recruited in a tertiary sleep center. Three OSA severity groups were determined by the Apnea-Hypopnea Index while three sleep duration groups were objectively determined by Total Sleep Time (TST). Dominant and non-dominant maximum and average HGS were calculated using a digital hand dynamometer. Short-sleeper individuals with OSA were found to have lower HGS indices than intermediate or sufficient sleepers with OSA while no differences in HGS indices among OSA severity groups were observed. All HGS indices correlated with TST. Future insights can be gleaned from the present results regarding the conceivably transdiagnostic relationship between sleep duration and HGS as well as the potential use of HGS as a marker in OSA. • Insufficient sleep duration was linked to lower hand grip strength (HGS) in OSA. • No link between OSA severity and HGS was observed in OSA. • HGS may serve as a high-yielding clinical marker in OSA. [ABSTRACT FROM AUTHOR]

• CMAP amplitude, muscle strength and walking capacity decrease after immobilisation and return to baseline levels after retraining. • Muscle velocity recovery cycles and MScanFit MUNE generally stay stable during short-term immobilisation and retraining. • Measures of the peripheral nervous system do not contribute to the changes observed in muscle strength and walking capacity. To explore the effects of short-term immobilisation and subsequent retraining on peripheral nervous system (PNS) measures using two novel electrophysiological methods, muscle velocity recovery cycles (MVRC) and MScanFit motor unit number estimation (MUNE) alongside lower limb muscle strength, muscle imaging and walking capacity. Twelve healthy participants underwent 1-week of ankle immobilisation and 2-weeks of retraining. Assessments before and after immobilisation, and after retraining, included MVRC [muscle membrane properties; muscle relative refractory period (MRRP), early and late supernormality ], MScanFit, MRI-scans [muscle contractile cross-sectional area (cCSA)], isokinetic dynamometry [dorsal and plantar flexor muscle strength], and 2-minute maximal walk test [physical function]. After immobilisation, compound muscle action potential (CMAP) amplitude reduced (-1.35[-2.00;-0.69]mV); mean change [95%CI]) alongside reductions in plantar (but not dorsal) flexor muscle cCSA (-124[-246;3]mm2), dorsal flexor muscle strength (isometric −0.06[-0.10;-0.02]Nm/kg, dynamic slow −0.08[-0.11;-0.04]Nm/kg, dynamic fast no changes), plantar flexor muscle strength (isometric −0.20[-0.30;-0.10]Nm/kg, dynamic slow −0.19[-0.28;-0.09]Nm/kg, dynamic fast −0.12[-0.19;-0.05]Nm/kg) and walking capacity (-31[-39;–23]m). After retraining, all immobilisation-affected parameters returned to baseline levels. In contrast, neither MScanFit nor MVRC were affected apart from slightly prolonged MRRP in gastrocnemius. PNS do not contribute to the changes observed in muscle strength and walking capacity. Further studies should include both corticospinal and peripheral mechanisms. [ABSTRACT FROM AUTHOR]

• Before and after lung transplantation (LT), patients often find it difficult to have independent gait functions. • Patients who need to have bridging extracorporeal membrane oxygenation applied before surgery had severe impairments in physical functioning. • At 3 months after LT, gait function and muscle strength were not significantly different regardless of extracorporeal membrane oxygenation use. • We may expect favorable early physical recovery after LT when systematic rehabilitation programs are applied. We aimed to investigate the recovery of gait function, muscle strength, and the achievement of an independent gait after lung transplantation (LT) in patients with and without pretransplant extracorporeal membrane oxygenation (ECMO) support. We retrospectively reviewed the medical records of 33 inpatients who underwent bilateral LT and received physical therapy. We assessed the Functional Ambulatory Category (FAC) and Manual Muscle Test (MMT) scores at baseline, 1 month, and 3 months of rehabilitation and the time it took to achieve a FAC score of 3 within 3 months of LT surgery in ECMO and non-ECMO patients. The FAC and MMT scores were generally improved during the first 3 months after LT. The number of patients who achieved a FAC score of 3 at 3 months did not significantly differ between the ECMO and non-ECMO groups (P =.193). At 1 month, significantly fewer patients had reached a FAC of 3 in the ECMO group than in the non-ECMO group (P =.042). There were no significant differences in the FAC (P =.398) and MMT scores (P =.079) at 3 months between the 2 groups. Both groups' gait function and muscle strength were continuously restored 3 months after LT. At 1 month, the gait function was assessed by the FAC score, and the rate to achieve a FAC of 3 was higher in the non-ECMO group than in the ECMO group, but at 3 months, the difference was not significant between the 2 groups. [ABSTRACT FROM AUTHOR]

Background In animal studies, a meal containing Alaska pollack protein (APP) induces fast-twitch muscle hypertrophy. To our knowledge, no interventional studies have examined the benefits of APP intake on muscle mass and muscle weakness and the prevention of sarcopenia in older individuals. Objectives We evaluated the effects of APP intake on skeletal muscle mass, muscle strength, and physical performance among healthy community-dwelling older Japanese women. Methods In this double-blind randomized controlled trial, healthy women ≥ 65 y old were allocated to an APP or whey protein control (CON) group. Participants ingested test protein meals (5.0–5.1 g protein/serving) daily for 24 wk. Between-group differences in the change of skeletal muscle mass index (SMI) as the primary outcome and muscle strength as a secondary outcome were tested using multifrequency BIA and a handheld dynamometer, respectively, at baseline, and 4, 12, and 24 wk. The mean changes in the measured primary and secondary outcome variables from baseline to 4, 12, and 24 wk were compared using unpaired t tests. Results There were no between-group differences in nutritional status, food intake, or total energy and protein intakes at baseline, 12 wk, or 24 wk. The change in SMI was 0.12 kg/m2 (95% CI: 0.01, 0.23 kg/m2) and 0.11 kg/m2 (95% CI: 0.03, 0.19 kg/m2) greater in the APP group than in the CON group at 12 wk and 24 wk (P  ≤ 0.03) and knee extension strength was 0.07 Nm/kg BW (95% CI: 0.02, 0.12 Nm/kg BW) and 0.05 Nm/kg BW (95% CI: 0.00, 0.09 Nm/kg BW) higher in the APP group than in the CON group at these times (P  ≤ 0.015), respectively. The groups did not differ at 4 wk. Conclusions Daily intake of a meal containing APP compared with whey protein increases skeletal muscle mass and lower-extremity muscle strength in healthy older women, suggesting that an APP-containing meal may be useful in the prevention of sarcopenia in this group. This trial was registered at as UMIN000035718. [ABSTRACT FROM AUTHOR]

To characterize lateral lumbar interbody fusion surgical learning curve and investigate changes in perioperative and postoperative clinical parameters associated with increased operative experience. In a case series, surgical learning curve was defined using 3-parameter asymptotic regression and piecewise linear regression, yielding learning phase (patients 1–53) and proficient phase (patients 54–179) cohorts. Using a 5-point grading scale, ipsilateral iliopsoas (hip-flexion) and quadriceps (knee-extension) muscle strength and thigh and groin sensory disturbances were compared for differences preoperatively versus postoperatively using χ2 test. Patient-reported outcome measures were collected preoperatively and postoperatively and compared between cohorts with unpaired t test. The proficient phase cohort demonstrated significantly reduced operative time, estimated blood loss, postoperative length of stay, and narcotic consumption on postoperative days 0 and 1. The proficient phase cohort displayed decreased disability at 6 weeks and 6 months and demonstrated significant improvement at all time points for disability, pain, and physical function except for 6 weeks and 2 years for physical function, whereas the learning phase cohort demonstrated improvement in disability beginning at 6 months, leg pain at all time points, and back pain through 6 months. Ipsilateral groin and thigh sensory disturbances and iliopsoas and quadriceps weakness improved with increasing operative experience. The proficient phase cohort demonstrated significantly improved perioperative profile, reduced complication rate, and reduced rates of iliopsoas and quadriceps weakness. While the proficient phase cohort demonstrated earlier improvement in disability and physical function scores compared with the learning phase cohort, 2-year outcome measures did not differ. Long-term clinical outcomes suggest that patient safety and quality of life are not compromised during the learning phase, but patients may be particularly susceptible to femoral nerve injury early in a surgeon's practice. [ABSTRACT FROM AUTHOR]

• This systematic review investigates the association between adherence to the Nordic diet and frailty among older adults. • Three studies (2 prospective cohort, 1 cross-sectional) reported across 6 papers were identified. • Greater compliance with the Nordic diet was associated with reduced frailty risk in women (one study). • Greater adherence to Nordic diet was associated with improved muscle strength (one study) and physical performance (two studies) in women, but no significant results were observed in men (two studies). • Greater adherence to the Nordic diet was associated with better mobility and functioning (one study) The Nordic or Baltic Sea diet is a healthy plant-based dietary pattern composed of foods originating from Nordic countries, closely related to the Mediterranean diet. Adherence to the Mediterranean diet has been found to be associated with a reduced risk of frailty. Although adherence to the Nordic diet has been associated with health benefits, little is known about its association with frailty. To investigate the evidence from observational studies regarding the association between the Nordic/Baltic Sea diet and frailty among older adults. Systematic review. Three databases (Medline/Ovid, Embase/Ovid, and Scopus) were systematically searched in February 2023 for observational studies examining the association between adherence to the Nordic diet and frailty among adults ≥60 years. The two authors independently assessed the full text of the papers for eligibility of studies and risk of bias. Three studies (the results of which were reported across 6 papers) met the inclusion criteria, among which one study (2 papers) included only women. Greater adherence to the Nordic diet was associated with a reduced risk of frailty measured by modified Fried criteria in women (one study). Moreover, greater adherence to the Nordic diet was associated with improved muscle (handgrip/leg) strength (one study) and physical performance (two studies), but these differences were seen only in women, with no significant results in men in two studies. Greater adherence to the Nordic diet was also associated with a lower risk of mobility limitations and improved ability to carry out self-care tasks (one study) and a borderline non-significant difference in Activities of Daily Living (one study). A meta-analysis was not performed due to heterogenous outcomes. Although all studies were of good quality, the results should be carefully interpreted due to methodological limitations. Adherence to the Nordic diet could be promising in reducing frailty risk, but more robust studies with equal gender representation and frailty-specific outcomes are needed. [ABSTRACT FROM AUTHOR]

Background: Nitrate supplements can improve vascular and muscle function. Whether higher habitual dietary nitrate is associated with better muscle function remains underexplored.Objective: The aim was to examine whether habitual dietary nitrate intake is associated with better muscle function in a prospective cohort of men and women, and whether the relation was dependent on levels of physical activity.Methods: The sample (n = 3759) was drawn from the Australian Diabetes, Obesity, and Lifestyle Study (AusDiab) (56% female; mean ± SD baseline age: 48.6 ± 11.1 y). Habitual dietary intake was assessed over 12 y by obtaining an average [of at least 2 time points, e.g., baseline (2000/2001) and 2004/2005 and/or 2011/2012] from a food-frequency questionnaire. Nitrate intake was calculated from a validated nitrate database and other published literature. Muscle function was quantified by knee extension strength (KES) and the 8-ft-timed-up-and-go (8ft-TUG) test performed in 2011/2012. Physical activity was assessed by questionnaire. Generalized linear models and logistic regression were used to analyze the data.Results: Median (IQR) total nitrate intake was 65 (52-83) mg/d, with ∼81% derived from vegetables. Individuals in the highest tertile of nitrate intake (median intake: 91 mg/d) had 2.6 kg stronger KES (11%) and 0.24 s faster 8ft-TUG (4%) compared with individuals in the lowest tertile of nitrate intake (median intake: 47 mg/d; both P < 0.05). Similarly, individuals in the highest tertile of nitrate intake had lower odds for weak KES (adjusted OR: 0.69; 95% CI: 0.47, 0.73) and slow 8ft-TUG (adjusted OR: 0.63; 95% CI: 0.50, 0.78) compared with those in the lowest tertile. Physical activity did not influence the relationship between nitrate intake and muscle function (KES; P-interaction = 0.86; 8ft-TUG; P-interaction = 0.99).Conclusions: Higher habitual dietary nitrate intake, predominantly from vegetables, could be an effective way to promote lower-limb muscle strength and physical function in men and women. [ABSTRACT FROM AUTHOR]

The aim of this study was to assess diaphragm thickness (DT) and mobility (DM) and to investigate their relationship to clinical parameters in patients with non-cystic fibrosis (non-CF) bronchiectasis. Thirty-eight patients with non-CF bronchiectasis were enrolled in this cross-sectional study. DT was measured using ultrasound at different lung volumes (at residual volume [DTRV], functional residual capacity [DTFRC] and total lung capacity [DTTLC]). DM was measured using ultrasound during quiet breathing (DMQB) and deep breathing (DMDB). Disease severity, pulmonary function, respiratory muscle strength, exercise capacity and physical activity were assessed. DTRV correlated with disease severity (ρ = 0.332, p = 0.042), FEV1% (r = 0.387, p = 0.016) and FVC% (r = 0.405, p = 0.012). DTFRC correlated with FVC% (r = 0.331, p = 0.042). DTTLC correlated with disease severity (r = 0.430, p = 0.007) and total physical activity time (r = 0.379, p = 0.019). DMDB correlated with disease severity (ρ = -0.380, p = 0.019), FEV1% (r = 0.369, p = 0.023) and FVC% (r = 0.405, p = 0.012). DT is related to disease severity, pulmonary function and physical activity, while DM is related to disease severity and pulmonary function in patients with non-CF bronchiectasis. [ABSTRACT FROM AUTHOR]

It is unclear whether the combined effects of exercise and nutrition are better than those of exercise alone or nutrition alone in older adults with sarcopenia. This paper assesses the comparative effects of exercise, nutrition, and the combination of exercise and nutrition on muscle mass, muscle strength, and physical performance in older adults with sarcopenia. In this systematic review and network meta-analysis, 11 electronic databases were searched up to November 2020. Inclusion criteria were: (1) adults aged 65 years and older with sarcopenia; (2) interventions of exercise, nutrition, or the combination of both; (3) the outcomes include at least one of the following: muscle mass, muscle strength (hand grip and knee extension strength), or physical performance (gait speed and dynamic balance); and (4) randomized control trials. For each outcome measurement, a network meta-analysis was conducted to determine the direct and indirect effects of each intervention compared with each of the other interventions. A total of 26 studies were included in the network meta-analysis. Compared with the control group, exercise alone and the combination of exercise and nutrition significantly increased handgrip strength (1.12 kg, 95% CI: 0.12, 2.11; 2.03 kg, 95% CI: 1.10, 2.97) and improved dynamic balance (-1.76 seconds, 95% CI: -2.24, -1.28; -1.02 seconds, 95% CI: -1.64, -0.39). Both exercise alone and the combination of exercise and nutrition have beneficial effects on muscle strength and physical performance in older adults with sarcopenia. [ABSTRACT FROM AUTHOR]

The objective of this systematic review and meta-analysis was to determine if there are sex-based differences in adaptations to resistance exercise training in healthy older adults. Following the screening process, data from 36 studies comparing older males and females (602 males; 703 females; ≥60 years of age) for changes in skeletal muscle size, muscle strength, and/or physical performance following the same resistance exercise training intervention were extracted. Mean study quality was 16/29 (modified Downs and Black checklist), considered moderate quality. Changes in absolute upper-body (Effect Size [ES] = 0.81 [95% CI 0.54, 1.09], P < 0.001), and lower-body (ES = 0.40 [95% CI 0.24, 0.56], P < 0.001) strength were greater in older males than females. Alternatively, changes in relative upper-body (ES = −0.46 [95% CI −0.77, −0.14], P < 0.01), and lower-body (ES = −0.24 [95% CI −0.42, −0.06], P < 0.01) strength were greater in older females than males. Changes in absolute, but not relative, whole-body fat-free mass (ES = 0.18 [95% CI 0.04, 0.33], P < 0.05) were greater in older males than females. There were no sex-based differences for absolute or relative changes in limb muscle size, muscle fiber size, or physical performance. • Absolute changes in upper- and lower-body strength are greater in older males. • Relative changes in upper- and lower-body strength are greater in older females. • Absolute changes in whole-body fat-free mass are greater in older males. • No sex-based differences for changes in muscle size at the limb or fiber level. • No sex-based differences for changes in physical performance. [ABSTRACT FROM AUTHOR]

• Short-term HVRT intervention improved the executive function of mobility-limited older adults. • Changes in lower-body muscle parameters and functional capacity were associated with changes in executive function. • Improvements in lower-body muscle parameters mediated the association between changes in executive function and functional performance. To examine the effect of high-velocity resistance training (HVRT) on the executive function of middle-aged and older adults with and without mobility limitations. Participants (n = 41, female: 48.9%) completed a supervised 12-week HVRT intervention (2 sessions/week; at 40–60% of one-repetition maximum). The sample included 17 middle-aged adults (40–55 years); 16 older adults (>60 years) and 8 mobility-limited older adults (LIM). Executive function was assessed before and after the intervention period and was reported as z-scores. Maximal dynamic strength, peak power, quadriceps muscle thickness, maximal isometric voluntary contraction (MVIC), and functional performance were also measured pre and post intervention. Training-related adaptations in cognitive measures were calculated using a Generalized Estimating Equation model. HVRT improved executive function in LIM (adjusted marginal mean differences [AMMD]: 0.21; 95%CI: 0.04, 0.38; p = 0.040) although no effect on middle-aged (AMMD: 0.04; 95%CI: -0.09; 0.17; p = 0.533) and older (AMMD: -0.11; 95%CI: -0.25; 0.02; p = 0.107) participants was observed. Improvements in maximal dynamic strength, peak power, MVIC, quadriceps muscle thickness, and functional performance were all associated with changes in executive function, and changes in the first four also seem to mediate the association between changes in functional performance and executive function. HVRT-induced improvement in executive function of mobility-limited older adults were mediated by changes in lower-body muscle strength, power, and muscle thickness. Our findings reinforce the relevance of muscle-strengthening exercises to preserve cognition and mobility in older adults. [ABSTRACT FROM AUTHOR]

Osteoporotic fractures present a major health problem with an increasing prevalence in older people. Fractures are associated with premature mortality, reduced quality of life, subsequent fracture, and increased costs. Hence, it is crucial to identify those at higher risk of fracture. Fracture risk assessment tools incorporated clinical risk factors to improve fracture predictive power over BMD alone. However, fracture risk prediction using these algorithms remains suboptimal, warranting further improvement. Muscle strength and physical performance measurements have been associated with fracture risk. In contrast, the contribution of sarcopenia, the composite condition of low muscle mass, muscle strength and/or physical performance, to fracture risk is unclear. It is uncertain whether this is due to the problematic definition of sarcopenia per se or limitations of the diagnostic tools and cut-off points of the muscle mass component. The recent position statement from the Sarcopenia Definition and Outcomes Consortium confirmed the inclusion of muscle strength and performance in the definition of sarcopenia but not DXA-assessed lean mass. Therefore, clinicians should focus on functional assessment (muscle strength and performance) rather than muscle mass, at least as assessed by DXA, as predictors of fractures. Muscle strength and performance are modifiable risk factors. Resistance exercise improves muscle parameters in the elderly, potentially leading to reduced risk of falls and fractures in the general population and in those who sustained a fracture. Therapists may consider exercise intervention to improve muscle parameters and potentially reduce the risk of fractures. The aim of this review was to explore 1) the contribution of muscle parameters (i.e., muscle mass, strength, and physical performance) to fracture risk in older adults, and 2) the added predictive accuracy of these parameters beyond the existing fracture assessment tools. These topics provide the rationale for investigating strength and physical performance interventions to reduce fracture risk. Most of the included publications showed that muscle mass is not a good predictor of fracture risk, while poor muscle strength and performance are associated with an increased risk of fracture, particularly in men, independent of age, BMD, and other risk factors for fractures. Muscle strength and performance can potentially improve the predictive accuracy in men beyond that obtained by the fracture risk assessment tools, Garvan FRC and FRAX. • Muscle strength and physical performance are associated with fracture risk. • Their rate of decline is associated with fractures independent of baseline values. • Muscle strength and physical performance significantly improve fracture prediction. • DXA-measured muscle mass shows inconsistent association with fracture risk. [ABSTRACT FROM AUTHOR]

Givinostat is a novel orally active histone deacetylase (HDAC) inhibitor developed for the treatment of DMD. The Epidys Study is a randomized, double blind, placebo controlled, multicenter Phase 3 study to evaluate the efficacy and safety of givinostat in ambulant DMD patients. One-hundred and seventy-nine DMD boys aged ≥6 years at baseline were enrolled and 95% of them completed the study. The primary efficacy assessment was the time to climb 4 standard stairs (4SC). The primary endpoint was complemented by six key secondary efficacy endpoints: time to rise from floor, distance walked in 6 minutes using 6-Minute Walk Test, physical function assessed by North Star Ambulatory Assessment (NSAA), knee extension and elbow flexion muscle strength, and fat fraction of vastus lateralis muscle (VL MFF) evaluated by magnetic resonance spectroscopy. Treatment duration was 18 months. Epidys Study met the primary endpoint with a significant difference between treatment and placebo arm in change from baseline at 18 months in 4SC (GLSmean ratio [SD] = 0.86 [0.071]; p=0.0345). Overall, treatment effect estimates relating to the key secondary endpoints also consistently favoured givinostat over placebo supporting the primary endpoint result, with treatment effects on total NSAA, cumulative loss of function, and VL MFF reaching nominal statistical significance with p <0.05. Safety and tolerability profile was acceptable. In conclusion, Epidys Study met its primary endpoint with consistent results in the key secondary endpoints. Safety and tolerability profile in Epidys Study was consistent with previous studies of givinostat. [ABSTRACT FROM AUTHOR]

This historical review summarizes the major advances – particularly from the last 50 years – in transcutaneous motor-level electrical stimulation, which can be used either as a tool to investigate neuromuscular function and its determinants (electrical stimulation for testing; EST) or as a therapeutic/training modality to improve neuromuscular and physical function (neuromuscular electrical stimulation; NMES). We focus on some of the most important applications of electrical stimulation in research and clinical settings, such as the investigation of acute changes, chronic adaptations and pathological alterations of neuromuscular function with EST, as well as the enhancement, preservation and restoration of muscle strength and mass with NMES treatment programs in various populations. For both EST and NMES, several major advances converge around understanding and optimizing motor unit recruitment during electrically-evoked contractions, also taking into account the influence of stimulation site (e.g., muscle belly vs nerve trunk) and type (e.g., pulse duration, frequency, and intensity). This information is equally important both in the context of mechanistic research of neuromuscular function as well as for clinicians who believe that improvements in neuromuscular function are required to provide health-related benefits to their patients. [ABSTRACT FROM AUTHOR]

• CVD is related to increased risks of both cross-sectional and prospective mobility impairments. • CVD is associated with higher risks of self-reported and injurious falls. • CVD particularly cerebrovascular disease may improve falls risk stratification. A few cross-sectional studies have highlighted inconsistent associations between cardiovascular disease (CVD) and musculoskeletal conditions. We sought to investigate the relationship between clinical CVD including subtypes, compromised muscle function, as well as incident self-reported and injurious falls in older women. 1431 community-dwelling older women (mean age ± SD; 75.2 ± 2.7 years) were included in over 14.5 years of a prospective study, the Perth Longitudinal Study of Ageing in Women. CVD (up to 18-years prior to the baseline visit) and injurious fall hospitalizations over 14.5 years were obtained from linked health records. Self-reported falls for five years were obtained via a written adverse event diary posted every four months. Timed-Up-and-Go (TUG) test and hand grip strength were used to assess mobility and muscle strength, respectively. Mobility impairment was defined as TUG performance >10.2 sec and muscle weakness characterized as grip strength <22 kg. Over 5-years, 411 (28.7%) women reported a falls, while 567 (39.6%) were hospitalized due to an injurious fall over 14.5 years. Prior CVD events were associated with 32% (HR 1.32 95%CI, 1.06–1.64) and 29% (HR 1.29 95%CI, 1.07–1.56) increased risk of self-reported and injurious falls, respectively, in multivariable-adjusted models. When considering subtypes of CVD, only cerebrovascular disease was related to self-reported (HR 1.77; 95%CI, 1.15–2.72) and injurious falls requiring hospitalization (HR 1.51; 95%CI, 1.00–2.27). CVD was also associated with cross-sectional and prospective mobility impairments. However, no evidence for such relationships was observed for muscle weakness. Prevalent CVD events, particularly cerebrovascular disease, are related to an increased risk of long-term falls. These findings highlight the need to recognize increased falls risk in patients with CVD. Further, there is a need to understand whether incorporating prevalent CVD into falls screening tools improves risk stratification or affects model calibration. [ABSTRACT FROM AUTHOR]

[Display omitted] • Vertebral fractures are associated with poor physical performance in older women • Vertebral fractures are associated with lower muscle strength in older women • Number of vertebral fractures influences associations between variables • Greater knee extensor strength is associated with better physical test performance Few studies have investigated the association between vertebral fragility fractures and lower limb muscle strength and physical performance in women with low bone mass. To explore whether the presence of vertebral fracture is independently associated with poor physical performance and decreased lower limb muscle strength. To understand whether lower limb muscle strength is associated with physical performance in women with vertebral fracture. Older women with low bone mass were divided into 2 groups: no vertebral fracture (NF) and presence of vertebral fragility fracture (VFF). Physical performance was evaluated using the Five Times Sit to Stand (5TSS) test, the Timed Up and Go (TUG) test and a 5m walk test (5MWT). Lower limb muscle strength was assessed using an isokinetic dynamometer. We included 94 women with low bone mass (mean age 71.6 [SD 5.7] years, time since menopause 24.4 [7.1] years, mean BMI 27.5 [5.1] kgm−2). VFF was only associated with low peak hip abductor torque (p = 0.001) after adjustments. In the VFF group (n= 47), each 1 Nmkg−1 increase: in knee extensor torque was associated with improved 5MWT (p = 0.005), TUG (p = 0.002) and 5TSS (p = 0.005) performances; in knee flexor torque was associated with improved 5MWT speed (p = 0.003) and TUG time (p = 0.006); in hip abductor torque was associated with improved 5MWT speed (p = 0.003); and in hip extensor torque with improved TUG time (p = 0.046). VFF was associated with reduced hip abductor strength in older women. However, the number of vertebral fractures influenced the association. Additionally, lower limb muscle strength was associated with physical performance, regardless of the clinical characteristics of the fractures. Therefore, strength and power training programs for the lower limbs could improve physical performance. [ABSTRACT FROM AUTHOR]

The aim of this narrative review is to discuss the evidence on exercise for fall, fracture and sarcopenia prevention, including evidence that aligns with the specificity and progressive overload principles used in exercise physiology, implementation strategies and future research priorities. We also provide a brief discussion of the influence of protein intake and creatine supplementation as potential effect modifiers. We prioritized evidence from randomized controlled trials and systematic reviews. Resistance training can improve muscle mass, muscle strength and a variety of physical performance measures in older adults. Resistance training may also prevent bone loss or increase bone mass, although whether it needs to be done in combination with impact exercise to be effective is less clear, because many studies use multicomponent interventions. Exercise programs prevent falls, and subgroup and network meta-analyses suggest an emphasis on balance and functional training, or specifically, anticipatory control, dynamic stability, functional stability limits, reactive control and flexibility, to maximize efficacy. Resistance training for major muscle groups at a 6–12 repetitions maximum intensity, and challenging balance exercises should be performed at least twice weekly. Choose resistance training exercises aligned with patient goals or movements done during daily activities (task specificity), alongside balance exercises tailored to ability and aspects of balance that need improvement. Progress the volume, level of difficulty or other aspects to see continuous improvement (progressive overload). A critical future priority will be to address implementation barriers and facilitators to enhance uptake and adherence. • Perform resistance exercises with high effort at least twice weekly, with progressive overload. • Balance training, targeting anticipatory and reactive control, dynamic stability, functional stability limits, and flexibility, prevents falls. • Practical tips and examples of exercises that consider task specificity are provided. • Future research should aim to understand and address barriers to implementation and adherence. [ABSTRACT FROM AUTHOR]

Limitations in physical function are common in Multiple Sclerosis (MS), yet it is neither clear how muscle power implicates physical function and walking-fatigability. This pilot-study aims to investigate (1) deficits in muscle power/force alongside walking in persons with MS; (2) associations between muscle power/force and physical functions and (3) the impact of prolonged walking in muscle power/force. 30 relapse-remitting persons with MS and 28 healthy controls performed chair rise and plantar flexion on a force platform before and after 12-minutes of intermittent walking to measure lower extremity muscle power/force. GaitRite measured walking speed. The percentage change in distance walked was also calculated. Persons with MS were classified into subgroups according to walking-fatigability and mobility disability status (Patient Determined Disease Steps). Higher deficits in muscle power compared to force were observed in persons with MS vs. healthy controls particularly in persons with MS having higher disability. Muscle power and force were associated with walking capacity, mobility disability and subjective fatigue, but not with percentage change in distance walked. Persons with MS slowed down over the course of the 12-min intermittent walking, whereas decrements in walking speed and muscle power/force (derived from chair rise) were observed in persons with MS presenting walking-fatigability only. Muscle power and force are impaired in persons with MS and appear to be critical for physical function in MS. This exploratory pilot study further suggests that muscle power/force from chair rise could contributes to walking-fatigability which therefore offer future treatment targets. • More pronounced deficit in muscle power vs. muscle force in persons with MS. • Muscle power/force were associated with walking capacity and mobility disability. • Muscle functions were associated with subjective fatigue but not with fatigability. • Persons with MS slowed down during 12-min of intermittent walking. [ABSTRACT FROM AUTHOR]

Paeonia lactiflora Pall. is an ethnopharmacological medicine with a long history of human use for treating various inflammatory diseases in many Asian countries. Aim of the study : Duchenne muscular dystrophy (DMD) is an X-linked degenerative muscle disease affecting 1 in 3500 males and is characterized by severe muscle inflammation and a progressive decline in muscle function. This study aimed to elucidate the effects of an ethanol extract of the root of Paeonia lactiflora Pall. (PL) on the muscle function in the muscular dystrophy X-linked (mdx) mouse, the most commonly used animal model of DMD. Male mdx mice and wild-type controls aged 5 weeks were orally treated with PL for 4 weeks. The corticosteroid prednisolone was used as a comparator drug. Muscle strength and motor coordination were assessed via the grip-strength and rotarod tests, respectively. Muscle damage was evaluated via histological examination and assessment of plasma creatine-kinase activity. Proteomic analyses were conducted to identify the muscle proteins whose levels were significantly affected by PL (ProteomeXchange identifier: PXD028886). Muscle and plasma levels of these proteins, and their corresponding mRNAs were measured using western blotting and ELISA, and quantitative reverse transcription–polymerase chain reaction, respectively. The muscle strength and motor coordination of mdx mice were significantly increased by the oral treatment of PL. PL significantly reduced the histological muscle damage and plasma creatine-kinase activity. Proteomic analyses of the muscle showed that PL significantly downregulated the high mobility group box 1 (HMGB1) protein and Toll-like receptor (TLR) 4, thus suppressing the HMGB1–TLR4–NF-κB signaling, in the muscle of mdx mice. Consequently, the muscle levels of proinflammatory cytokines/chemokines, which play crucial roles in inflammation, were downregulated. PL improves the muscle function and reduces the muscle damage in mdx mice via suppressing the HMGB1-TLR4-NF-κB signaling and downregulating proinflammatory cytokines/chemokines. [Display omitted] • Paeonia lactiflora ethanol extract (PL) restores muscle function in mdx mice. • PL reduces muscle damage and plasma creatine kinase activity. • Muscle proteome analysis shows that PL downregulates HMGB1. • PL suppresses the HMGB1-TLR4-NF-κB signaling in the muscle. • PL downregulates cytokine and chemokine expression in the muscle. [ABSTRACT FROM AUTHOR]

In the literature, it is thought that spine or pelvic malalignment and changes in the abdominal muscle structure may affect the uterine position and cause menstrual pain. However, the overall lumbopelvic structure related to lumbopelvic muscle endurance, thickness, alignment, and mobility in women with primary dysmenorrhea has not been well investigated. This study aimed to compare women with primary dysmenorrhea and asymptomatic controls in terms of lumbopelvic structure. Women with primary dysmenorrhea (primary dysmenorrhea group, n: 38, age: 21 years (18–28), body mass index (BMI): 20.70 (17.31–28.73) kg/m2) and without primary dysmenorrhea (asymptomatic group, n: 39, age: 20 years (19–23), BMI: 20.83 (17.31–27.10) kg/m2) were included. The severity of menstrual pain, lumbopelvic muscle endurance, morphology, alignment, and mobility were assessed with the Visual Analogue Scale, McGill trunk muscle endurance tests, ultrasonographic imaging, and a Valedo® Shape device, respectively. The median value of the menstrual pain in the primary dysmenorrhea group was 6.5 cm (min-max: 4.0–10.0). Lumbopelvic muscle endurance (p < 0.001), muscle thickness (p < 0.001), frontal lumbar angle (p: 0.05), sagittal pelvic mobility (p < 0.001), and frontal lumbar mobility (p: 0.002) were lower in the primary dysmenorrhea group compared to the asymptomatic group. Muscle endurance, thickness, alignment, and mobility of the lumbopelvic structure in women with primary dysmenorrhea compared to asymptomatic women have been affected negatively. These findings should be considered in management of primary dysmenorrhea. • Lumbopelvic muscle endurance and thickness have reduced in primary dysmenorrhea. • Biomechanical changes in the spine may be important in primary dysmenorrhea. • Decrease in lumbopelvic mobility may be seen in women with primary dysmenorrhea. [ABSTRACT FROM AUTHOR]

Human skeletal muscle fiber is heterogenous due to its diversity of slow- and fast-twitch fibers. In human, slow-twitched fiber gene expression is correlated to MOTS-c, a mitochondria-derived peptide that has been characterized as an exercise mimetic. Within the MOTS-c open reading frame, there is an East Asian-specific m.1382A>C polymorphism (rs111033358) that changes the 14th amino acid of MOTS-c (i.e., K14Q), a variant of MOTS-c that has less biological activity. Here, we examined the influence of the m.1382A>C polymorphism causing MOTS-c K14Q on skeletal muscle fiber composition and physical performance. The myosin heavy chain (MHC) isoforms (MHC-I, MHC-IIa, and MHC-IIx) as an indicator of muscle fiber composition were assessed in 211 Japanese healthy individuals (102 men and 109 women). Muscular strength was measured in 86 physically active young Japanese men by using an isokinetic dynamometer. The allele frequency of the m.1382A>C polymorphism was assessed in 721 Japanese athletes and 873 ethnicity-matched controls. The m.1382A>C polymorphism genotype was analyzed by TaqMan SNP Genotyping Assay. Individuals with the C allele of the m.1382A>C exhibited a higher proportion of MHC-IIx, an index of fast-twitched fiber, than the A allele carriers. Men with the C allele of m.1382A>C exhibited significantly higher peak torques of leg flexion and extension. Furthermore, the C allele frequency was higher in the order of sprint/power athletes (6.5%), controls (5.1%), and endurance athletes (2.9%). Additionally, young male mice were injected with the MOTS-c neutralizing antibody once a week for four weeks to mimic the C allele of the m.1382A>C and assessed for protein expression levels of MHC-fast and MHC-slow. Mice injected with MOTS-c neutralizing antibody showed a higher expression of MHC-fast than the control mice. These results suggest that the C allele of the East Asian-specific m.1382A>C polymorphism leads to the MOTS-c K14Q contributes to the sprint/power performance through regulating skeletal muscle fiber composition. • There is an East Asian-specific m.1382A>C polymorphism in the mtDNA that changes the 14th amino acid of MOTS-c (i.e., K14Q). • C allele of the MOTS-c m.1382A>C showed a higher percentage of MHC-IIx and muscular strength than the A allele. • C allele frequency of the MOTS-c m.1382A>C polymorphism overrepresented in the sprint/power athletes. • MOTS-c neutralizing, mimicking C allele, showed lower and higher expression of MHC-slow and -fast than controls. [ABSTRACT FROM AUTHOR]

• Unsupervised home-based resistance training seems safe in older adults. • Low-to-moderate adherence rates are found with these exercise programs. • These interventions appear effective for improving different fitness measures. • This training emerges as a practical and economic option for older adults. We aimed to summarize evidence on the safety, adherence and effectiveness of home-based resistance training (UHBRT) for improving health-related endpoints in community-dwelling older adults. Randomized controlled trials of UHBRT in older adults (≥60yrs) were included after a systematic search (PubMed, CINAHL, PsycInfo, SPORTDiscus, Web of Science, MEDLINE, Cochrane Central Register of Controlled Trials) until 02/19/2021. Adverse events and adherence rates were assessed as indicators of feasibility. Other endpoints included physical (muscle strength, muscle power, balance, physical performance) and mental-related measures (cognition, quality of life [QoL]) as well as other health-related variables (body composition, physical activity levels, falls). 21 studies (N = 4,053) were included. No major adverse events were reported, with adherence averaging 67 % (range 47–97 %). UHBRT significantly improved lower-limb muscle strength (Hedges' g = 0.33; 95 % confidence interval [CI] = 0.11−0.57), muscle power measured through the sit-to-stand test (g = 0.44; 95 %CI = 0.06−0.84), and balance (assessed with the postural sway, g = 0.32; 95 %CI = 0.16−0.49). No benefits were found for other strength indices (handgrip strength), balance (single leg stance and functional reach test), physical performance (walking speed, TUG and SPPB), QoL, nor for the risk or rate of falls (all p > 0.05, g<0.61). No meta-analysis could be performed for the remaining endpoints. Although efforts are needed to increase adherence, preliminary evidence suggests that UHBRT can be safe and modestly effective for improving some measures of lower-limb muscle strength, balance, and muscle power in community-dwelling older adults. However, no benefits were found for other physical fitness measures, QoL or falls. More evidence is therefore needed to draw definite conclusions. [ABSTRACT FROM AUTHOR]

• Aerobic exercise (AE) can be recommended for individuals with Parkinson's disease. • AE promotes benefits in gait parameters, mobility, and lower limb muscle strength. • There was no significant improvement in quality of life with the AE. • AE on a treadmill or in the form of walking were used most. • Based on the GRADE approach, the level of synthesized evidence was low to very low. Objectives: To investigate the effect of aerobic exercise (AE) on functional capacity and quality of life in individuals with Parkinson's disease (PD) in the mild to moderate stages. Data Sources: Medline, Embase, Web of Science, The Cochrane Library, Lilacs and PEDro were searched from inception until January 2021 using the MeSH terms. Study Selection: Studies conducted in individuals with PD involving AE compared to a control group were included. Data extraction: Characteristics of the studies were independently extracted by two reviewers. The PEDro scale was used to assess the methodological quality, and the level of evidence was analyzed and synthesized using the GRADE approach. Data Synthesis: Of the ten studies, 411 individuals with PD were included. The level of synthesized evidence for cardiorespiratory function was low and without effect, and very low and without effect. For gait was very low and with effect for speed and stride length and without effect for cadence. For mobility was very low and with effect. For muscle strength was very low and with effect for the lower limbs as well as without effect for the upper limbs. For postural balance was very low and without effect. For quality of life was low and without effect. Conclusion: Aerobic exercise was capable of promoting improvements in gait (walking speed and stride length), mobility, and lower limb muscle strength in individuals with PD in the mild to moderate stages. No significant improvement in quality of life was found due to the practice of AE. [ABSTRACT FROM AUTHOR]

[Display omitted] • Pulmonary function and physical function are often impaired in childhood cancer. • Patients with pulmonary dysfunction are often asymptomatic. • Physical function testing could unmask impairments undetectable by screening. • There is a gap in the literature in diaphragm function in childhood cancer. • Pulmonary function tests could be augmented by inspiratory muscle testing. Children with cancer experience pulmonary and physical function side effects from the cancer itself and the medical interventions. This systematic review examines the known relationship between pulmonary function and physical function in childhood cancer and identifies gaps in the literature. A search of Ovid Medline, CINAHL (EbscoHost) and Embase to identify literature from 2009 to March 2020. Fifty-seven studies met inclusion criteria. Thirty-seven studies reported impaired pulmonary function. Incidence of pulmonary dysfunction ranged from 45.5 % to 84.1 %. Eighteen studies reported impaired physical function. Three studies investigated the relationship between pulmonary function and physical function. No studies explored inspiratory muscle strength. Pulmonary function and physical function are related and frequently impaired in children during and after cancer treatment. A literature gap was found in diaphragm function and its relationship with physical function. Future studies should focus on interventions that target the pulmonary mechanisms impacting physical function. [ABSTRACT FROM AUTHOR]

Infiltration of muscle with non-lean tissue, such as fat, reduces muscle quality. Ultrasound captures muscle quality through measurement of echogenicity. Given the potential implications of quadriceps muscle quality on physical function, particularly in knee osteoarthritis, the purpose of this study was to investigate the relationship between echogenicity, muscle thickness and subcutaneous fat thickness with the clinical severity of osteoarthritis. Thirty-one women with clinical knee osteoarthritis participated. Rectus femoris and vastus lateralis echogenicity, muscle thickness and subcutaneous fat thickness were measured from ultrasound images of the most symptomatic knee. Clinical severity of osteoarthritis was characterized with pain, self-reported function, six-minute walk test, and knee extensor strength. Correlation coefficients were calculated between muscle and fat architecture outcomes (muscle quality, muscle and fat thicknesses) and osteoarthritis clinical severity outcomes. Data from 25 women were of sufficient quality for analysis. Echogenicity (muscle quality) related to the six-minute walk test for both rectus femoris (r = −0.52, p = 0.02) and vastus lateralis (r = −0.74, p = 0.004), with poorer muscle quality related to lower mobility. Subcutaneous fat thickness was related to the six-minute walk test (rectus femoris, r = −0.61, p = 0.0012; vastus lateralis, r = −0.73, p = 0.003) and strength (rectus femoris, r = −0.46, p = 0.02; vastus lateralis, r = −0.59, p = 0.03). Muscle thickness was not related to any severity outcomes. Muscle quality, rather than thickness, is associated with mobility performance in women with knee osteoarthritis. Thus, interventions for osteoarthritis that specifically target muscle quality, rather than size, should be explored. • Quadriceps muscle quality was related to mobility in knee osteoarthritis. • Muscle fattiness, rather than size, is potentially more important in osteoarthritis. • Muscle quality may be captured using ultrasound-measured echogenicity. [ABSTRACT FROM AUTHOR]

Severe primary hyperparathyroidism may be associated with muscle weakness and fatigue, but little is known about this effect in milder forms of the disease. This study aimed to evaluate physical function and quality of life in patients with normocalcemic (NPHPT) and hypercalcemic (HPHPT) primary hyperparathyroidism. This was a case-control study on 40 postmenopausal women. Thirteen patients with NPHPT, 7 patients with HPHPT, and their controls were studied. Mean serum PTH in the control group was 49.10 ± 12.38 pg/mL. All of the participants answered the Medical Outcomes Short-Form Health Survey (SF36) and were submitted to 2 strength tests (Hand Grip strength and Chair stand test) and 2 performance tests for physical function (Short physical performance battery and Gait speed). Body composition analysis was performed by dual-energy X-ray absorptiometry (DXA) and multifrequency bioimpedance (BIA). Patients with NPHPT had lower grip strength (p = 0.005), a higher mean time of the chair stand test (p = 0.012), a lower mean gait speed (p < 0.001) and a lower score for the Short Physical Performance Battery (SPPB) (p = 0.010) than the control group. Patients with HPHPT had lower handgrip strength (p = 0.027), a higher mean time of the chair stand test (p = 0.017), and a lower score for the SPPB (p = 0.049) than the control group. Patients with NPHPT showed a higher gait speed when compared to HPHPT (p = 0.048). There was no difference between BIA and DXA body composition indices between the PHPT groups and their controls. The evaluation of the SF-36 showed significantly less quality of life in the general health domain among the NPHPT group and in the mental health domain among the HPHPT than in the controls. Patients with NPHPT and HPHPT have decreased physical performance and strength. • Normocalcemic Primary hyperparathyroidism (NPHPT) is associated with muscle weakness. • Hypercalcemic Primary hyperparathyroidism (HPHPT) is associated with muscle weakness. • NPHPT and HPHPT patients have decreased physical performance compared to controls. • There were no differences comparing the muscle composition between controls and PHPT patients. [ABSTRACT FROM AUTHOR]