Protocol Version 1

Validation Bundle With Grip Strength

A three-part bundle using grip strength, 5x sit-to-stand, and fatigue survey data to validate whether the Energy Score tracks measured strength, functional output, and symptom burden.

All Protocols Measured Function Score Back to Mito Map

Strength / Reserve

Grip Strength

3 trials per hand

Use the best value from each hand. Record dominant hand, body position, and dynamometer model.

Functional Performance

5x Sit-to-Stand

1 timed set

Use the same chair and instructions each visit. Record total time in seconds.

Lived Burden

Fatigue Survey

1 short questionnaire

Use the same instrument each visit. Convert the survey to a normalized fatigue burden score.

Measurement Steps

Detailed Protocol

Collect the Energy Score and the measured bundle on the same day whenever possible.
Grip strength: seated if possible, shoulder neutral, elbow near 90 degrees, forearm neutral, wrist in comfortable neutral position.
Grip strength: complete three maximal squeezes per hand with 15 to 30 seconds rest between trials.
Record the best value from each hand and note which hand is dominant.
5x sit-to-stand: use a standard-height chair, ask the participant to stand up and sit down five times as quickly and safely as possible, ideally with arms folded if safe.
Fatigue survey: use the same validated survey at every visit rather than changing instruments between visits.

Visit Setup

Time Of Day And Pre-Test Conditions

Try to measure at the same time of day for each visit, ideally within the same 2-hour window.
Morning or late morning is usually best because it reduces variability from accumulated daytime exertion.
Record whether the participant is fasting, post-meal, acutely ill, sleep-deprived, menstruating, or recovering from unusual exertion.
Record caffeine use, pain flare, recent medication changes, and any assistive-device use that might affect performance.
If the person has post-exertional worsening, do the fatigue survey before the physical tests.

Consistency matters more than choosing the perfect time. A repeatable routine is more valuable than a theoretically ideal one.

Grip Protocol

How To Measure Grip Strength

Use the same dynamometer model at every visit whenever possible.
Use the same handle setting at every visit unless hand size makes that impossible.
Preferred position: seated, feet flat, back supported, shoulder adducted and neutral, elbow at about 90 degrees, forearm neutral.
Ask for one short submaximal practice squeeze before formal testing if the person is unfamiliar with the device.
Then perform three maximal efforts per hand, alternating hands if helpful, with 15 to 30 seconds of rest between attempts.
Record every trial, but use the best value from the strongest hand for the calculator.
Document dominant hand, hand pain, arthritis, neuropathy, tremor, or recent upper-extremity injury.

Chair Protocol

Exact 5x Sit-to-Stand Setup

Use a standard, stable chair without wheels.
Preferred seat height is about 43 to 46 cm, which is roughly 17 to 18 inches.
Use the same chair for every visit in the same participant whenever possible.
Place the chair on a non-slip surface with clear space around it.
Standard instruction: sit with back against the chair, feet flat, stand up fully and sit down fully five times as quickly and safely as possible.
Preferred method is arms folded across the chest, but if arms are used for safety, record that clearly and keep the method consistent at future visits.
Start timing on “go” and stop when the participant stands fully at the end of the fifth repetition.
Record the time in seconds and note any abnormal mechanics, hesitation, balance concern, or need for arm assistance.
If the participant holds the chair, pushes off repeatedly, or uses steady hand support, record that because the measured-function calculator applies a penalty for assisted completion.

Fatigue Protocol

How To Measure Fatigue

Use one fatigue instrument consistently rather than switching surveys between visits.
A practical option is the Fatigue Severity Scale if you want something short and familiar.
Administer the survey before performance testing if exertion could worsen symptoms the same day.
Ask the participant to answer based on their recent usual state, not just how they feel in the last few minutes.
Normalize the survey to a 0 to 100 fatigue burden score before comparing it to the measured-function calculator.
Record whether the fatigue score reflects a typical day, a flare day, or a recovery day after unusual exertion.

The most important fatigue rule is consistency: same survey, same framing, same scoring conversion.

Frequency

Recommended Visit Schedule

Scenario	Cadence	Notes
First validation pilot	Baseline, then every 4 weeks for 3 months	Best default for early signal without overburdening follow-up.
Routine tracking	Every 6 to 8 weeks	Reasonable when expected changes are slower.
After major intervention change	Baseline, 2 to 4 weeks, then 8 to 12 weeks	Useful for separating noise from a sustained response.

Best default: run the full bundle every 4 weeks during the first 12 weeks of validation.

Standardization

How To Reduce Noise

Use the same dynamometer model each time.
Measure at similar times of day when possible.
Note acute illness, recent hard exertion, sleep disruption, or hand pain.
Keep the chair height and sit-to-stand instructions constant.
Record fatigue before any strenuous testing if post-exertional worsening is a concern.

Minimum Data Capture

What To Record At Every Visit

Date and exact time of testing.
Sex, age, and any major clinical change since the last visit.
Best grip strength by hand and strongest-hand value used for scoring.
5x sit-to-stand time and whether arms were used.
Whether chair support was none, light, or moderate during sit-to-stand.
Fatigue survey raw score and normalized fatigue burden score.
Any acute confounders: illness, flare, poor sleep, unusual exercise, pain, injury, or medication change.