Journal of Gerontology: MEDICAL SCIENCES Copyright 2007 by The Gerontological Society of America

2007, Vol. 62A, No. 5, 543–549

Reliability of Maximal Voluntary Muscle Strength

and Power Testing in Older Men
E. Todd Schroeder,1,3 Ying Wang,2 Carmen Castaneda-Sceppa,4 Gregory Cloutier,4
Alberto F. Vallejo,1,3 Miwa Kawakubo,2 Nicole E. Jensky,1 Susan Coomber,4
Stanley P. Azen,2 and Fred R. Sattler1,3

Departments of 1Biokinesiology and Physical Therapy, 2Preventive Medicine, and 3Medicine, Keck School of Medicine,
University of Southern California, Los Angeles.
4
Nutrition, Exercise Physiology and Sarcopenia Laboratory,
Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University, Boston, Massachusetts.

Background. Maximal voluntary muscle strength (MVMS) and leg power are important measures of physical function
in older adults. We hypothesized that performing these measures twice within 7–10 days would demonstrate a .5%
increase due to learning and familiarization of the testing procedures.

Methods. Data were collected from three studies in older adult men (60–87 years) and were divided into two cohorts
defined by study site and type of exercise equipment. MVMS was assessed in 116 participants using the one-repetition
maximum method at two separate study visits for the chest press, latissimus pull-down, leg press, leg flexion, and leg
extension exercises along with unilateral leg extension power.

Results. Test–retest scores were not different and did not exceed 0.8 6 9.0% in Cohort 1 or 2.3 6 9.8% in Cohort 2,
except for leg extension, which improved by 6.6 6 14.4% ( p , .009) and 3.4 6 6.8% ( p , .016), respectively. Repeat
tests were closely correlated with initial tests (all p , .001). Pearson correlation coefficients ranged from 0.74 for leg
extension power to 0.96 for leg press. Coefficients of variation were ,10% (4.2%–9.0%) for all exercises except for leg
extension power, which was 15.5%.

Conclusions. Our findings demonstrated that test–retest measures of MVMS and power in older adult men do not
differ by more than 2.3% except for leg extension, and have relatively low coefficients of variation using data collected
from three studies. Moreover, these findings were similar between two study sites using different equipment, which further
supports the reliability of MVMS and power testing in older adult men.

M EASURES of maximal voluntary skeletal muscle

strength and power are essential indicators of phys-
ical function in older adults (1–3) and are important for
may limit performance during the initial evaluation session
in those individuals not accustomed to such testing (8,9).
Such psychological factors may contribute to submaximal
quantifying outcomes of study interventions. Few studies performance on the initial evaluation followed by improve-
obtain multiple assessments of maximal voluntary muscle ments in subsequent testing sessions.
strength (MVMS) and power prior to interventions, which The test–retest reliability of measures of maximal skeletal
may result in an overestimation of the success of the inter- muscle strength in older adults have primarily been limited to
vention (e.g., resistance training regimens, anabolic drug isokinetic and isometric protocols (6,10,11) or handheld
therapies) if there is learning or familiarization with the dynamometers (12). Similar studies have been conducted in
testing procedures. This is of particular importance in older young adults with the majority of investigations assessing
adults in whom improvements in strength may be small but reliability using isokinetic dynamometers (13). One-repetition
have functional significance. maximum (1-RM) testing has been validated in older adult
In a previous study (4), we reported average strength populations (14–19), is relatively safe (20), and is preferred to
gains of approximately 11% following 12 weeks of treat- multiple repetition-maximum testing (e.g., 5-RM or 10-RM),
ment with an anabolic androgen in older adults. Performing which requires estimations to obtain maximal strength values
two baseline strength assessments allowed us to confidently and often is limited by muscular fatigue. However, few
accept any changes in strength as a direct result of the study studies (5,16,19,21) have reported test–retest reliability for
intervention rather than attribute those changes to learning MVMS using the 1-RM method in older adults, and those
and familiarization which may account for 5%–10% of the few were limited to lower body exercises.
gains (5,6). Indeed, evidence suggests that in untrained older Regardless, performing multiple pre-intervention assess-
adults, a single testing session will result in neural facil- ments of MVMS and power to familiarize participants with
itation and motor-learning adaptations that enhance strength testing procedures may be impractical in some older persons
(5,7). Therefore, subsequent testing sessions may demon- with limited access to travel and resources (e.g., facilities or
strate improvements in strength and power due to these training personnel). Thus, it is important to validate the
adaptations. Apprehension about performing maximal efficacy of performing repeated measures of 1-RM strength
strength and power exercises in a laboratory environment of both upper and lower body muscle groups and leg

543
544 SCHROEDER ET AL.

extension power prior to study interventions. We, therefore, Evaluation of Muscle Strength
hypothesized that performing these tests twice within 7–10 MVMS was assessed using the 1-RM method (23) at the
days would demonstrate a greater than 5% increase due test and retest visits 7–10 days apart. The 1-RM was defined
to learning and familiarization. Additionally, we sought to as the greatest resistance that could be moved through
compare the test–retest reliability for the same measures a defined range of motion using proper technique. Prior to
conducted at a different university participating in our strength testing, participants warmed up on a cycle ergom-
multicenter study. eter or by walking for 5 minutes. At the first testing session,
participants were instructed how to perform the selected
exercises and were allowed to practice the exercises with
METHODS minimal resistance. After the participants were comfortable
with the equipment, they performed five warm-up repeti-
Study Design tions at low intensity (estimated to be
50% of partic-
The data reported here are from three studies in older adult ipant’s 1-RM based on his perceived exertion during
men (n ¼ 116). The first study (Study 1, n ¼ 16) was an familiarization) and 3–5 repetitions at higher intensity
investigator-initiated, dose-ranging, double-blind, placebo- (estimated to be
75% of his 1-RM) for each exercise.
controlled trial to determine the dosing effect of an oral The resistance was increased with each subsequent attempt,
androgen on muscle and metabolism (4). The second study and the magnitude of increase estimated so that the partic-
(Study 2, n ¼ 32) was an investigator-initiated, double-blind, ipant failed at his respective maximum in fewer than eight
placebo-controlled investigation to determine the magnitude attempts (to avoid fatigue). Ninety seconds of rest was given
and durability of effects of an anabolic androgen (18,22). The between each repetition attempt. The total test time to
third study (Study 3, n ¼ 42) was a multicenter, investigator- complete the 1-RM assessments for all exercises was 45–60
initiated, double-blind, placebo-controlled investigation to minutes. These procedures were standardized for all studies
determine the effects of testosterone and growth hormone on and at both study sites.
muscle and metabolism. All studies were performed at the At USC, the 1-RM was determined for the bilateral leg
University of Southern California (USC) National Center for press, leg extension, leg flexion, latissimus pull-down (lat
Research Resources (NCRR)–funded General Clinical Re- pull), and chest press exercises on Keiser A-300 pneumatic
search Center and the Clinical Exercise Research Center in equipment (Keiser Corp., Fresno, CA). The leg press and
the Department of Biokinesiology & Physical Therapy. Study chest press machines displayed force as Newtons. Because
3 was also performed at the Nutrition, Exercise Physiology Newtons cannot be accurately converted to kilograms on
and Sarcopenia Laboratory in the Jean Mayer USDA Human these machines, strength data are reported as Newtons for
Nutrition Research Center on Aging (HNRCA), Tufts the two exercises at USC. Additionally, the leg flexion and
University (n ¼ 26). The studies and informed consents were extension exercises were not performed in Study 1. At the
approved and annually reviewed by the Institutional Review HNRCA site, all exercises (bilateral leg press, leg extension,
Boards of both the Los Angeles County–USC Medical leg flexion, lat pull, and chest press) were performed on
Center and the Tufts–New England Medical Center. selectorized weight-stack resistance exercise machines
(Cybex VR2; Cybex International Inc., Medway, MA), on
Study Population which the measures of force are reported in kilograms. The
Men 60–87 years of age were recruited from the Los greatest 1-RM measured for each exercise during the two
Angeles communities surrounding the USC Health Sciences strength testing sessions was used as the value for MVMS.
Campus and the greater Boston area. In brief, to be eligible The same investigators performed all tests for each partic-
for these studies, participants must not have participated in ipant at their respective study sites.
regular resistance training, physical activity (with the excep-
tion of a walking program), or competitive sports for the
Evaluation of Muscle Power
previous 6 months. Participants had to have a body mass
Unilateral leg extension power (W) using the Bassey
index (BMI)
35 kg/m2, repeated resting blood pressure
Power Rig (University of Nottingham, Nottingham, U.K.)
, 180/95 mmHg, prostate specific antigen (PSA)
4.1 ng/
was only determined at USC for Studies 2 and 3, and has
mL, serum hematocrit
50%, alanine aminotransferase less
been described elsewhere (24). In brief, participants are
than three times the upper limit of normal, and serum cre-
seated and place the right foot on the foot pedal with the
atinine , 2 mg/dL. Participants with untreated endocrine
arms folded and trunk slightly forward. The participants are
abnormalities (e.g., diabetes, hypothyroidism), active in-
instructed to perform the leg extension procedure exerting as
flammatory conditions, or cardiac problems (heart failure,
much force as possible and as fast as possible. At least 10–
myocardial infarction, or angina) in the proceeding 3
12 trials were performed until a plateau was reached and the
months were excluded. A maximal cycle ergometer exercise
highest score achieved was recorded for leg power.
test with a ramped protocol, 12-lead electrocardiogram, and
blood pressure monitoring to achieve a heart rate  85% of
age-predicted maximum was administered prior to resis- Body Composition by Dual-Energy X-Ray
tance exercise testing to identify participants at possible risk Absorptiometry
for exercise-induced cardiac ischemia, abnormalities in heart Whole-body dual-energy x-ray absorptiometry (DEXA)
rhythm, or abnormal blood pressure response during scans (Hologic QDR-4500, version 7.2 software; Waltham,
exercise testing. MA) were performed to quantify total and regional lean
 RELIABILITY OF STRENGTH TESTING IN OLDER MEN 545

Table 1. Demographic and Body Composition Characteristics of Study Cohorts

Cohort 1 (N ¼ 90) Cohort 2 (N ¼ 26)
Variable Mean 6 SD Median (Range) Mean 6 SD Median (Range) p Value
Age, y 72 6 5 71 (60–87) 69 6 3 69 (65–77) .005
Height, m 1.74 6 0.07 1.74 (1.58–1.91) 1.76 6 0.08 1.80 (1.60–1.90) .18
Weight, kg 82.5 6 11.9 80.9 (55.9–115.9) 84.4 6 10.7 84.7 (63.9–104.7) .42
Body mass index, kg/m2 27.2 6 3.5 27.2 (19.0–36.6) 27.3 6 3.3 26.5 (22.7–36.1) .91
Total lean body mass, kg 60.8 6 10.9 57.6 (45.4–97.4) 59.8 6 6.5 59.2 (46.6–72.5) .55
% Fat 26.4 6 5.7 26.2 (12.4–41.8) 26.2 6 4.6 26.1 (16.8–36.6) .93
Notes: Cohort 1: University of Southern California (USC) using Keiser resistance machines; Cohort 2: Human Nutrition Research Center on Aging (HNRCA)
using Cybex selectorized weight-stack resistance machines.
SD ¼ standard deviation.

body mass and fat mass. One blinded, experienced tech- is confirmed by the small (, 10%) CV from all exercises
nician analyzed all scans for both sites. The coefficient of (range from 4.2% to 9.0%) (Table 2) except for the Bassey
variation (CV) for repeated measures was , 1% for lean and leg extension power, which had a CV of 15.5%. In addition,
fat mass. there was a strong linear association between the test and
retest as confirmed by the large Pearson correlation coef-
Statistical Considerations ficients (Cohort 1: range from 0.74 for the Bassey power
Statistical analyses were performed by site (USC, Cohort test to 0.94 for the chest press; Cohort 2: range from 0.91
1; HNRCA, Cohort 2). Analyses for Cohort 1 (n ¼ 90) for the chest press to 0.98 for the leg extension, all p values
included data from Studies 1, 2, and 3, and analyses for , .0001).
Cohort 2 (n ¼ 26) included data from Study 3. For each Table 3 summarizes the test–retest differences for MVMS
cohort, summary statistics were calculated for demographic and power. For Cohort 1, the absolute mean change was 0,
characteristics (age, height, weight, BMI) as well as body except for leg press (5 6 146 Newtons), leg extension (3 6
composition variables from the DEXA scan (total lean body 7 kg), and the Bassey power test (3.8 6 39.8 W). No
mass and % fat). Pearson correlation coefficients were used significant difference was detected for most strength tests
to determine the association between the test and retest (p . .05) except for the leg extension test where an average
values for the strength variables. In addition, we calculated improvement of 3 6 7 kg was found to be statistically
the absolute change (retest–test) and the relative change significant (p ¼ .012). Similar results were observed for
((retest–test)/test) 3 100), and tested for their significance the relative change, where there was no significant change
using a Student paired t test. Random effect analysis of (p . .05) except for the leg extension where we observed
variance (ANOVA) was conducted to contrast between- and a 6.6 6 14.4% improvement comparing retest to test values
within-person variability to calculate CVs using the fol- (p ¼ .009). We observed consistent results for Cohort 2 with
lowing formula: CV ¼ 100 3 (within-person standard devia-
tion [SD]/within-person mean). For these analyses, the test
variables were log transformed. Bland–Altman plots were Table 2. Absolute Values and Pearson Correlation Coefficients for
used to describe the mean change for each exercise in both Maximal Muscle Strength and Power
cohorts. All results are reported at the .05 level of signifi- Correlation
cance (two-sided), and all analyses were performed using Strength Test N Test Retest CV%* Coefficienty
SAS 9.0 (Cary, NC). Cohort 1
Leg press, Newtons 88 1367 6 328z 1372 6 328 6.3 0.90
Chest press, Newtons 88 224 6 50 224 6 50 5.3 0.94
RESULTS Leg flexion, kg 70 66 6 13 66 6 12 7.8 0.84
Table 1 summarizes the demographic as well as body Lat pull, kg 88 55 6 12 55 6 12 5.9 0.91
composition characteristics of the two cohorts that were Leg extension, kg 37 63 6 15 66 6 14 9.0 0.88
similar except for age. Data from a total of 116 participants Bassey power, W 73 185.5 6 53.4 181.6 6 57.0 15.5 0.74
were analyzed, 90 from Cohort 1 and 26 from Cohort 2. In Cohort 2
Cohort 1, the following number of participants did not Leg press, kg 26 126 6 27 128 6 29 4.2 0.96
perform the retest for these exercises: 2 for the leg press, Chest press, kg 25 58 6 11 57 6 12 7.9 0.91
chest press, and lat pull; 4 for the leg flexion; 5 for the leg Leg flexion, kg 26 49 6 12 50 6 13 7.0 0.93
extension; and 1 for the leg extension power test. In Cohort Lat pull, kg 24 94 6 14 94 6 13 4.4 0.92
Leg extension, kg 26 75 6 20 78 6 20 4.7 0.98
2, 1 participant did not perform the retest for the chest press
and 2 participants did not perform the lat pull exercises. Notes: Cohort 1: University of Southern California (USC) using Keiser
Reasons for not completing these tests included sore joints resistance machines; Cohort 2: Human Nutrition Research Center on Aging
(HNRCA) using Cybex selectorized weight-stack resistance machines.
(n ¼ 11), fatigue (n ¼ 2), or missed appointments (n ¼ 2). CV ¼ coefficient of variation; lat pull ¼ latissimus pull-down.
The MVMS and power tests are reported in Table 2. We *CV ¼ 100 3 (within-person standard deviation [SD]/within-person mean).
observed consistent retest patterns across the tests for both y
All values significant, p , .001.
z
study cohorts. The consistency across the two repeated tests Mean 6 SD.
546 SCHROEDER ET AL.

Table 3. Absolute and Relative Change for Maximal Muscle Strength and Power
Absolute Change* Relative Change (%)y
z
Test N Mean 6 SD Median (Range) p Value Mean 6 SD Median (Range) p Valuez
Cohort 1
Leg press, Newtons 88 5 6 146 2 (506 to 734) .75 0.8 6 9.0 0.1 (26 to 40) .43
Chest press, Newtons 88 0 6 17 0 (60 to 40) .84 0 6 7.4 0 (25 to 20) .96
Leg flexion, kg 70 0 6 7 0 (26 to 29) .83 0.6 6 12.0 0 (26 to 64) .67
Lat pull, kg 88 0 6 5 0 (27 to 18) .72 0.7 6 8.0 0 (37 to 26) .44
Leg extension, kg 37 3 6 7 3 (13 to 26) .012 6.6 6 14.4 4.2 (19 to 59) .009
Bassey power, W 73 4 6 40 0 (101 to 84) .41 0.4 6 20.8 0 (43 to 60) .88
Cohort 2
Leg press, kg 26 3 6 8 4 (16 to 18) .11 2.0 6 5.8 2.9 (10 to 15) .10
Chest press, kg 25 1 6 5 2 (14 to 11) .17 3.0 6 10 3.4 (33 to 19) .21
Leg flexion, kg 26 1 6 5 0 (11 to 9) .26 2.3 6 9.8 0 (23 to 22) .24
Lat pull, kg 24 0 6 6 0 (11 to 14) .83 0.0 6 6.4 0 (10 to 20) .97
Leg extension, kg 26 3 6 4 2 (7 to 9) .006 3.4 6 6.8 3.3 (16 to 17) .016
Notes: Cohort 1 ¼ University of Southern California (USC) using Keiser resistance machines; Cohort 2 ¼ Human Nutrition Research Center on Aging (HNRCA)
using Cybex selectorized weight-stack resistance machines.
SD ¼ standard deviation; lat pull ¼ latissimus pull-down.
*Absolute change ¼ Retest value  Test value.
y
Relative change ¼ (Absolute change/Test value) 3 100.
z
Paired t test.

no significant change ( p . .10) in absolute values for the retest scores for all but the leg extension exercise in our two
leg press (3 6 8 kg), chest press (1 6 5 kg), leg flexion (1 cohorts. In fact, the other five exercises performed differed by
6 5 kg), and lat pull (0 6 6 kg). The leg extension exercise less than 0.7% in the test–retest data analyzed for Cohort 1,
showed a significant 3 6 4 kg (p ¼ .006) absolute and 3.4 6 and had CVs less than 8% (except for leg extension power,
6.8% (p ¼ .016) relative increase from test to retest. which demonstrated the highest CV of 15.5%). Similarly,
Bland–Altman plots are presented in Figures 1 and 2 with except for leg extension, the maximum difference for the four
the x axis representing the average of the test–retest scores exercises in Cohort 2 was only 2.3% with a maximum CV of
and the y axis representing the difference of the test–retest 7.8%. The higher CV of 15.5% for leg power may relate to
scores for each exercise. The plots from Cohort 1 (Figure 1) the fact that this test is technique dependent; we speculate that
show a mean change of 0 for the leg press, chest press, leg it is somewhat more difficult to learn.
flexion, and lat pull exercises. The leg extension exercise A second important finding is that the results are data
shows a mean change . 0 and more variability from test to compiled from three different studies in older adults con-
retest. Additionally, the Bassey leg extension power dem- ducted at one study site and corroborated by data collected
onstrated a small decrease in mean change with large in older adults from a second study site using different
variability among participants from test to retest. The plots equipment. The likelihood of demonstrating test–retest
from Cohort 2 (Figure 2) show a mean change near 0 for the reliability for strength and power testing should be greater
leg press, chest press, leg flexion, and lat pull exercises, with when data from multiple studies and study sites are included
the leg extension exercise showing the greatest mean change in the analyses. The reliability between test–retest measures
and variability from test to retest. of strength and power is further supported by the fact that
data collection methods differed (e.g., type of exercise
machines, testers).
DISCUSSION It is noteworthy that the leg extension exercise was the
Our findings demonstrate that performing two tests prior only measurement to show significant improvement in test–
to study interventions to account for familiarization and retest scores in both cohorts. Cohort 1 demonstrated a 6.6 6
learning may not be necessary in older adult men for most 14.4% (p ¼ .009) increase from test to retest, with Cohort 2
strength and power tests. We hypothesized that performing showing a smaller but also significant increase from test to
one test followed by a second test 7–10 days later would result retest of 3.4 6 6.8% (p ¼ .016). A possible explanation for
in a greater than 5% increase in MVMS and power measure- this finding in Cohort 1 may be the small sample size of 37
ments in our two cohorts. We theorized that the improvement compared to the 70 or 88 participants analyzed for the other
in strength and power in a subsequent testing session would exercises. However, Cohort 2 demonstrated the same find-
be the result of familiarization and learning of the testing ing with a sample size of 26 for the leg extension exercise
procedures. Indeed, reports by other investigators (6,21,25) and showed nonsignificant changes in four other exercises
have demonstrated improvements after repeat measurements with a sample size ranging from 24 to 26. Thus, this finding
without intervention in older adults, and have attributed those is difficult to explain and may be inherent to measurement of
improvements to motor learning adaptations. Contrary to strength for the leg extension exercise. Salem and colleagues
these previous reports and rejecting our hypothesis, there (5) reported a significant 2.9% reduction in 1-RM strength
were nonsignificant improvements of less than 2.3% in test– for leg extension from Test 1 to Test 2 in persons aged
 RELIABILITY OF STRENGTH TESTING IN OLDER MEN 547

Figure 1. Bland–Altman plots for Cohort 1 (University of Southern California [USC]): leg press (A), chest press (B), leg flexion (C), latissimus pull-down (D), leg
extension (E), and Bassey leg extension power (F). SD ¼ standard deviation.

51–78 years. Therefore, multiple baseline evaluations of multiple session testing (11), and have reported larger CVs
MVMS for the leg extension exercise should be performed compared to 1-RM testing (13,21). Findings from Ordway
as there appear to be inconsistent findings across studies. and colleagues (13) demonstrated large CVs using isokinetic
Previous reports on the reliability of strength testing using dynamometry even with a familiarization session. Although
isokinetic dynamometers have demonstrated the need for the importance of a familiarization session on strength
548 SCHROEDER ET AL.

Figure 2. Bland–Altman plots for Cohort 2 (Tufts): leg press (A), chest press (B), leg flexion (C), latissimus pull-down (D), and leg extension (E). SD ¼ standard
deviation.

measurements has been reported (26), we did not perform Although our findings may be of value to geriatric
a separate familiarization session for 1-RM strength testing, researchers and clinicians, there are several limitations to
and we report CVs that are less than the average (8%–10%) consider. First, our results relate only to relatively healthy,
reported in other studies for isokinetic and isometric testing community-dwelling older men as tested in these studies.
in older adults (11). Performing 1-RM testing in younger populations or older
 RELIABILITY OF STRENGTH TESTING IN OLDER MEN 549

persons with known heart or lung disease, hypertension, or 5. Salem GJ, Man-Ying W, Sigward S. Measuring lower extremity
other chronic conditions may not produce the same results, strength in older adults: the stability of isokinetic versus 1RM
measures. J Aging Phys Act. 2002;10:489–503.
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evaluate test–retest reliability of maximal strength and women. Arch Phys Med Rehabil. 1993;74:1181–1185.
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ACKNOWLEDGMENTS
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in-aid from Savient Pharmaceuticals and Solvay Pharmaceuticals, by the 2004;96:1055–1062.
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4. Schroeder ET, Singh A, Bhasin S, et al. Effects of an oral androgen on Received April 18, 2006
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