Increase in echo intensity and extracellular-to-intracellular water ratio is independently associated with muscle weakness in elderly women

Eur J Appl Physiol. 2017 Oct;117(10):2001-2007. doi: 10.1007/s00421-017-3686-x. Epub 2017 Jul 28.


Purpose: The changes in muscle composition and its heterogeneity during aging are associated with muscle weakness in elderly persons independent of decreases in muscle mass or muscle thickness (MT). Both the assessment of echo intensity (EI) with ultrasound imaging and the evaluation of the extracellular water/intracellular water (ECW/ICW) ratio with segmental bioelectrical impedance spectroscopy (BIS) are non-invasive and convenient methods and seem valuable for muscle quality determination. However, no previous study has evaluated both EI and the ECW/ICW ratio simultaneously to investigate their relationship to muscle strength. The purpose of the present study was to investigate whether both EI and the ECW/ICW ratio are independently associated with muscle strength in elderly women.

Methods: A total of 179 elderly women with a mean age of 74.1 ± 4.9 years, living independently in the community, were enrolled. The MT and EI of the quadriceps femoris were measured using transverse ultrasound imaging. The ECW/ICW ratio in the upper thigh was calculated from segmental BIS. The maximum knee extensor strength and the presence of knee pain were also assessed.

Results: Knee extensor strength showed a significant positive correlation with MT, and significant negative correlations with EI, the ECW/ICW ratio, and age. Stepwise regression analysis revealed that knee extensor strength in elderly women was predicted by MT, EI, and the ECW/ICW ratio.

Conclusions: This study suggests that the simultaneous application of EI and the ECW/ICW ratio is useful in assessing muscle strength, and accurately estimates the changes in muscle quality related to muscle weakness.

Keywords: Echo intensity; Extracellular water; Muscle quality; Muscle strength; Muscle thickness.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Dielectric Spectroscopy / methods
  • Extracellular Space / diagnostic imaging*
  • Extracellular Space / metabolism
  • Female
  • Humans
  • Muscle Strength
  • Muscle Weakness / diagnostic imaging*
  • Muscle Weakness / metabolism
  • Muscle Weakness / physiopathology
  • Quadriceps Muscle / diagnostic imaging*
  • Quadriceps Muscle / growth & development
  • Quadriceps Muscle / metabolism
  • Ultrasonography / methods
  • Water / metabolism


  • Water