This study aimed to use ultrasound imaging to provide objective data on the effects of ageing and gender on relative thickness of quadriceps muscle and non-contractile tissue thickness (subcutaneous fat, SF, combined with perimuscular fascia). In 136 healthy males and females (aged 18-90 years n = 63 aged 18-35 years; n = 73 aged 65-90) images of the anterior thigh (dominant) were taken in relaxed supine using B-mode ultrasound imaging. Thickness of muscle, SF and perimuscular fascia were measured, and percentage thickness of total anterior thigh thickness calculated. Independent t-tests compared groups. Correlation between tissue thickness and BMI was examined using Pearson's coefficient. Muscle thickness was: 39 ± 8 mm in young males, 29 ± 6 mm in females, 25 ± 4 mm in older males and 20 ± 5 mm in females. Percentage muscle to thigh thickness was greater in young participants (p = 0.001). Percentage SF and fascia was 17 ± 6% in young and 26 ± 8% in older males, 32 ± 7% in young and 44 ± 7% in older females. BMI was similar for age and correlated moderately with non-contractile tissue (r = 0.54; p < 0.001) and poorly with muscle (r = -0.01; p = 0.93). In conclusion, this novel application of ultrasound imaging as a simple and rapid means of assessing thigh composition (relative thickness of muscle and non-contractile tissue) may help inform health status, e.g. in older people at risk of frailty and loss of mobility, and aid monitoring effects of weight loss or gain, deconditioning and exercise.

The aim of the present study was to determine the validity of ultrasound (US) imaging versus magnetic resonance imaging (MRI) for measuring anterior thigh muscle, subcutaneous adipose tissue (SAT), and fascia thickness. Twenty healthy, moderately active participants (aged 49.1 ± 9.74 (36–64) years), underwent imaging of the anterior thigh, using ultrasound and MRI modalities on the same day. Images were analyzed offline to assess the level of agreement between US and MRI measurements. Pearson’s correlation coefficient showed an excellent relationship between US imaging and MRI for measuring muscle (r = 0.99, p < 0.01), SAT (r = 0.99, p < 0.01), and non-contractile tissue (SAT combined with perimuscular fascia) thickness (r = 0.99, p < 0.01). Perimuscular fascia thickness measurement showed a poor correlation between modalities (r = 0.39, p < 0.01). Intra-class correlation coefficients (ICC3,1) also showed excellent correlation of the measurements with ICC = 0.99 for muscle thickness, SAT, and non-contractile tissue, but not for perimuscular fascia, which showed poor agreement ICC = 0.36. Bland and Altman plots demonstrated excellent agreement between US imaging and MRI measurements. Criterion validity was demonstrated for US imaging against MRI, for measuring thickness of muscle and SAT, but not perimuscular fascia alone on the anterior thigh. The US imaging technique is therefore applicable for research and clinical purposes for muscle and SAT.

Patient and public involvement and engagement (PPIE) is essential for improved research outcomes and reduced research waste. To be effective, PPIE should provide opportunities for diverse groups to contribute to all research stages. However, UK ethnic minority communities remain underrepresented in research. This article describes strategies adopted in a public health research project that were effective in building trust and increasing inclusion of ethnic minority communities. The study team of researchers and PPIE partners reflects lessons learnt during the project and describe six main strategies that built meaningful levels of trust and inclusion: 1) early start to recruitment of PPIE partners; 2) relationship-focused engagement; 3) co-production and consultation activities; 4) open communication and iterative feedback; 5) co-production of project closure activities, and; 6) diverse research team. Meaningful outcomes for the community included the involvement of people from ethnic minorities as research participants and PPIE partners, community wellbeing, co-production of public health recommendations co-presented at the UK Houses of Parliament, and consortium-wide impact evidenced by the enrolment of 51 active PPIE partners. PPIE partners reflect on their research involvement, offering advice to researchers and encouraging people from ethnic minority communities to take part in research. An important message from PPIE partners is that involvement should not be restricted to projects specific to ethnic minorities but become a routine part of general population research, recognising ethnic minorities as an integral part of UK society. In conclusion, this article demonstrates that with appropriate strategies, inclusion and diversity can be achieved in public health research. We recommend researchers, practitioners and policy makers adopt these strategies when planning their public health projects.

Purpose: This study aimed to systematically examine the influence of various muscle and experimental conditions on Myoton recordings. Methods: A cross-sectional, observational design was used to examine muscle conditions and experimental factors (different recording sites, muscle length, level of contraction and prior physical activity) that may influence reproducibility of Myoton recordings for biceps brachii (BB) and rectus femoris (RF). Fifty-three healthy adults (26 young, 27 older) aged 18–90 years were studied. Muscle stiffness, tone and elasticity were measured using the MyotonPRO device. Results: Statistically significant differences in Myoton parameters were found for aspects of all four muscle and experimental conditions compared with the control condition ($p<0.05$ ). However, clinically relevant differences in tone, stiffness and elasticity were only found for contracted compared to resting muscle, with changes being greater than the minimal detectable change. Elasticity was not affected by prior activity. Conclusions: The conditions studied significantly altered Myoton parameters of BB and RF in healthy adults, but only changes in parameters during muscle contraction were clinically relevant. These findings provide evidence to support the need to consider muscle condition and experimental factors for improving the robustness of test protocols for assessing muscle mechanical properties using the MyotonPRO device.