# What Is ‘Muscle Health’? A Narrative Review and Conceptual Framework

## TL;DR

This paper reviews how 'muscle health' is defined and measured in recent studies, proposing a framework to standardize its assessment.

## Contribution

The paper introduces a conceptual framework for muscle health based on the ICF model to standardize its definition and measurement.

## Key findings

- Most studies use multiple metrics to assess muscle health, with body composition and muscle mass being the most common.
- A standardized framework for muscle health is proposed using the International Classification of Functioning, Disability and Health model.
- Common assessment tools include DXA, grip strength, and gait speed.

## Abstract

Background: Muscle health is an emerging concept linked to physical performance and functional independence. However, the term lacks a standardized definition and is often used as a broad muscle-related outcome descriptor. Clinical communication and research would benefit from a conceptual model of muscle health grounded in an established framework. Methods: We conducted systematic search and narrative synthesis to identify multifactorial measurement approaches explicitly described under ‘muscle health’. PubMed and CINAHL were searched for clinical and randomized controlled trials published in the past 5 years (final search: March 2025) that used the term “muscle health.” Studies were reviewed for explicit definitions of “muscle health,” and all identified outcomes (e.g., strength, mass) and measurement tools (e.g., grip strength, ultrasound) were synthesized. This review was retrospectively registered (INPLASY202580069). Results: Of the 65 clinical or randomized controlled trials that met inclusion criteria, 29 provided an operational definition of ‘muscle health’, while 36 inferred measurements without a clear definition. The identified measurements spanned four primary categories, with body composition/muscle mass being the most common (92.3%), followed by muscle performance (78.5%), physical function (63.1%), and tissue composition (30.8%). Most studies included more than one muscle health metric (93.9%). Common assessment methods included DXA (44.6%), grip strength (64.6%), and gait speed (27.7%). Conclusions: While there are common measurement approaches, the definition of muscle health varies widely in the cited works. The framework of the International Classification of Functioning, Disability and Health, was used to identify domains aligned with muscle health components of muscle morphology/morphometry (e.g., mass and composition), functional status (performance-based tasks), and physical capacity (muscle performance). This framework provides a structured basis for evaluating muscle health in research and clinical practice. Consistent use of these domains could enhance assessment and support efforts to standardize testing and interpretation across settings.