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This study aimed to investigate if changing the midsole bending stiffness of athletic footwear can affect the onset of lower limb joint work redistribution during a prolonged run.Fifteen trained male runners (10-km time of44 min) performed 10-km runs at 90% of their individual speed at lactate threshold (i.e., when change in lactate exceeded 1 mmol/L during an incremental running test) in a control and stiff shoe condition on 2 occasions. Lower limb joint kinematics and kinetics were measured using a motion capture system and a force-instrumented treadmill. Data were acquired every 500 m.Prolonged running resulted in a redistribution of positive joint work from distal to proximal joints in both shoe conditions. Compared to the beginning of the run, less positive work was performed at the ankle (approximately 9%; p ≤ 0.001) and more positive work was performed at the knee joint (approximately 17%; p ≤ 0.001) at the end of the run. When running in the stiff shoe condition, the onset of joint work redistribution at the ankle and knee joints occurred at a later point during the run.A delayed onset of joint work redistribution in the stiff condition may result in less activated muscle volume, because ankle plantar flexor muscles have shorter muscles fascicles and smaller cross-sectional areas compared to knee extensor muscles. Less active muscle volume could be related to previously reported decreases in metabolic cost when running in stiff footwear. These results contribute to the notion that footwear with increased stiffness likely results in reductions in metabolic cost by delaying joint work redistribution from distal to proximal joints.

Background The net metabolic cost of walking (NCw) and the co-activation of leg muscles are both higher in old adults (OG) than in young adults (YG). Nevertheless, the relation between the two remains unresolved, mainly due to the controversial co-activation measurement method used in previous studies. Research question To compare ankle and knee co-contraction (CCI), calculated using an EMG-driven method, between the groups and to examine their relationship with NCw. Methods Nine young (YG = 25.2 +/- 3.3 years old) and nine older (OG = 68.7 +/5.9 years old) adults walked on a treadmill at five speeds (YG: 1; 1.2; 1.4; 1.6; 1.8 m/s; OG: 0.6; 0.8; 1; 1.2; 1.4 m/s) while electromyography (sEMG) and oxygen consumption were measured. CCI were calculated around the ankle and knee for different parts of the gait cycle (entire gait cycle 0–100 %, stance phase 0–60 %, swing phase 60–100 %). Results NCw was significantly higher (25 %, averaged over the walking speeds) in OG as were Knee_CCI, Knee_CCI_swing and Knee_CCI_stance. Multiple regression models in YG, OG and YG + OG highlighted Ankle_CCI as the main contributor in NCw (β = 0.08−0.188, p Significance The present findings provide a better understanding of the association between muscle co-contraction and metabolic cost in older adults. It may help scientists and clinicians to further develop strategies aimed at neuromuscular rehabilitation as a means of improving mobility and independence among older adults.

Background: The Gait Profile Score (GPS) provides a composite measure of the quality of joint movement during walking, but the relationship between this measure and metabolic cost, temporal (e.g. walking speed) and spatial (e.g. stride length) parameters in stroke survivors has not been reported. Research Question: The aims of this study were to compare the GPS (paretic, non-paretic, and overall score) of young stroke survivors to the healthy able-bodied control and determine the relationship between the GPS and metabolic cost, temporal (walking speed, stance time asymmetry) and spatial (stride length, stride width, step length asymmetry) parameters in young stroke survivors to understand whether the quality of walking affects walking performance in stroke survivors. Methods: Thirty-nine young stroke survivors aged between 18 and 65years and 15 healthy age-matched able-bodied controls were recruited from six hospital sites in Wales, UK. Joint range of motion at the pelvis, hip, knee and ankle, and temporal and spatial parameters were measured during walking on level ground at self-selected speed with calculation of the Gait Variable Score and then the GPS. Results: GPS for the paretic leg (9.40° (8.60–10.21) p < 0.001), non-paretic leg (11.42° (10.20–12.63) p < 0.001) and overall score (11.18° (10.26–12.09) p < 0.001)) for stroke survivors were significantly higher than the control (4.25° (3.40–5.10), 5.92° (5.11 (6.73)). All parameters with the exception of step length symmetry ratio correlated moderate to highly with the GPS for the paretic, non-paretic, and/or overall score (ρ =

Objectives. This study evaluated the effects of wearing the Laevo v2.56 exoskeleton (Laevo, The Netherlands) on physiological parameters related to working load and metabolic cost (MC) during a lifting task, explored the variability in exoskeleton performance among users and determined whether perceived discomfort negatively correlates with a reduction in MC. Methods. Twenty participants completed a 4-min repetitive lifting task with/without the exoskeleton. Respiratory gases, heart rate, blood lactate and ratings of perceived exertion and experienced discomfort were collected, and MC was calculated. Results. Wearing the exoskeleton significantly reduced MC and oxygen uptake during the lifting task by 4.8 and 3.8%, respectively. Workload reduction occurred in 65% of the participants. Conclusion. The Laevo v2.56 exoskeleton reduced MC and workload in a repetitive lifting task in a subject-dependent manner. Future studies should focus on identifying factors that could cause performance variability such as user-robot interaction forces.

The elastic function of running-specific prostheses likely contributes to a lower metabolic cost of running. However, it remains unclear whether running-specific prostheses provide advantages concerning the metabolic cost of running in relationship with nonamputee runners. This study aimed to systematically review the scientific literature to examine the peak performance (peak oxygen consumption-VO2peak and peak speed) and the metabolic cost between paired amputees and nonamputees during running and between amputee runners with traditional prostheses and running-specific prostheses. A literature search on three databases (MEDLINE/PubMed, Scopus, and Web of Science) was conducted using the following key words: (amputation OR amputee) AND (run OR running OR runner) AND (prosthesis OR prosthetics), resulting in 2060 records and 4 studies within the inclusion criteria. A methodological quality assessment was carried out using a modified version of the Downs and Black checklist. VO2peak of the amputees athletes (54 ± 2 mL kg-1 min-1) is similar (mean difference = -0.80 mL kg-1 min-1, confidence interval = -4.63 to 3.03) to nonamputees athletes (55 ± 2 mL kg-1 min-1). The average metabolic cost of the paired amputee athletes (4.94 ± 1.19 J kg-1 m-1) also does not differ (mean difference = 0.73 J kg-1 m-1, confidence interval = -0.74 to 2.20) from nonamputee runners (4.21 ± 0.16 J kg-1 m-1). The research on running in amputee and nonamputee athletes is limited. The few existing studies have limited methodological quality. The metabolic cost data from amputee athletes running with running-specific prostheses are within the range of nonamputee data.

BACKGROUND: Population aging is now a universal trend. Many elderly persons can only conduct limited and short time walking because of age-related skeletal muscle decline of the lower limbs. The wearable device for walking assistance is beneficial to improve the life quality of the elderly. OBJECTIVE: This study aimed to propose a soft exosuit for walking assistance of the elderly and verify its feasibility. METHODS: The wearable structure and control strategy were presented. The performance of the soft exosuit was tested by force tracking evaluation and metabolic cost test. RESULTS: The mean error of the measured and target peak force was 1.1%. The metabolic cost with assistance on while wearing the exosuit was reduced by 9.2% compared with that in locomotion assistance off. The reduction of assistance on was 7.1% compared with no exosuit. CONCLUSIONS: The proposed soft exosuit has the potential to improve the walking efficiency of the elderly.

BACKGROUND Lower-limb amputees have increased metabolic costs during walking that may be mitigated by maintaining quadriceps strength and power following amputation. However, there are no current studies investigating the relationship between thigh strength and walking performance in individuals with transfemoral amputation. OBJECTIVE To quantify the relationship between intact limb quadriceps strength in transfemoral amputees and six-minute walk test (6MWT) performance. DESIGN Descriptive laboratory study. SETTING Laboratory. PARTICIPANTS Eleven participants with unilateral transfemoral amputations from trauma or osteosarcoma (4 women/7 men, 46.21 ± 12.68 years old, 28.24 ± 20.57 years following amputation). INTERVENTIONS Strength and power testing on the intact limb followed by 6MWT with a flowmeter to measure oxygen uptake (VO2 ). MAIN OUTCOME MEASURES Strength included mass-normalized peak torque, average torque, and average power. 6MWT measures included total distance traveled and VO2 normalized to distance and mass. Significant correlations (P ≤ .05) were retained for a regression analysis. RESULTS Peak isokinetic knee extensor torque was correlated with total VO2 (r = -.60, P = .05) and distance traveled (r = .84, P = .001). Average isokinetic knee extensor torque was correlated with total VO2 (r = -.61, P = .046) and distance traveled (r = .85, P = .001). Average knee extensor power was correlated with total VO2 (r = -.67, P = .026) and distance traveled (r = .88, P

Background Emphasizing the active use of the arms and coordinating them with the stepping motion of the legs may promote walking recovery in patients with impaired lower limb function. Yet, most approaches use seated devices to allow coupled arm and leg movements. To provide an option during treadmill walking, we designed a rope-pulley system that physically links the arms and legs. This arm-leg pulley system was grounded to the floor and made of commercially available slotted square tubing, solid strut channels, and low-friction pulleys that allowed us to use a rope to connect the subject’s wrist to the ipsilateral foot. This set-up was based on our idea that during walking the arm could generate an assistive force during arm swing retraction and, therefore, aid in leg swing. Methods To test this idea, we compared the mechanical, muscular, and metabolic effects between normal walking and walking with the arm-leg pulley system. We measured rope and ground reaction forces, electromyographic signals of key arm and leg muscles, and rates of metabolic energy consumption while healthy, young subjects walked at 1.25 m/s on a dual-belt instrumented treadmill (n = 8). Results With our arm-leg pulley system, we found that an assistive force could be generated, reaching peak values of 7% body weight on average. Contrary to our expectation, the force mainly coincided with the propulsive phase of walking and not leg swing. Our findings suggest that subjects actively used their arms to harness the energy from the moving treadmill belt, which helped to propel the whole body via the arm-leg rope linkage. This effectively decreased the muscular and mechanical demands placed on the legs, reducing the propulsive impulse by 43% (p p = 0.001). Conclusions These findings provide the biomechanical and energetic basis for how we might reimagine the use of the arms in gait rehabilitation, opening the opportunity to explore if such a method could help patients regain their walking ability. Trial registration: Study registered on 09/29/2018 in ClinicalTrials.gov (ID—NCT03689647).

Background: Previous studies suggested that automated peritoneal dialysis (APD) could be improved in terms of shorter treatment times and lower glucose absorption using bimodal treatment regimens, having ‘ultrafiltration (UF) cycles’ using a high glucose concentration and ‘clearance cycles’ using low or no glucose. The purpose of this study is to explore such regimes further using mathematical optimization techniques based on the three-pore model. Methods: A linear model with constraints is applied to find the shortest possible treatment time given a set of clinical treatment goals. For bimodal regimes, an exact analytical solution often exists which is herein used to construct optimal regimes giving the same Kt/ V urea and/or weekly creatinine clearance and UF as a 6 × 2 L 1.36% glucose regime and an ‘adapted’ (2 × 1.5 L 1.36% + 3 × 3 L 1.36%) regime. Results: Compared to the non-optimized (standard and adapted regimes), the optimized regimens demonstrated marked reductions (>40%) in glucose absorption while having an identical weekly creatinine clearance (35 L) and UF (0.5 L). Larger fill volumes of 1200 mL/m2 (UF cycles) and 1400 mL/m2 (clearance cycles) can be used to shorten the total treatment time. Conclusion: These theoretical results imply substantial improvements in glucose absorption using optimized APD regimens while achieving similar water and solute removal as non-optimized APD regimens. While the current results are based on a well-established theoretical model for peritoneal dialysis, experimental and clinical studies need to be performed to validate the current findings.

Osteoarthritis (OA) affects a large percentage of older adults. Prevalence of OA in younger adults is growing due to traumatic joint injuries occurring through sport participation. The purpose of this review is to summarize the recent literature linking lower extremity musculoskeletal injuries to post-traumatic osteoarthritis (PTOA), summarize the biomechanical and movement strategy consequences of these injuries, and link these consequences with known metabolic risk factors associated with general OA specifically in the aging population. Approximately 30% of younger adults have radiographic OA within one year after traumatic knee injury. An estimated 50% of individuals with chronic ankle instability will suffer from PTOA. Injuries to lower limb joints can lead to alterations in movement patterns, which may result in detrimental joint loading. This may be contributing to this accelerated development of PTOA. Older age, independent of OA, is also associated with gait alterations as well as greater metabolic cost of movement and greater fatigability. It is hypothesized that individuals suffering from PTOA as younger adults may be at a greater risk for these metabolic consequences due to the accelerated timeframe of OA onset and associated functional declines of older age. The potential consequences of PTOA in lower limb joints paired with advancing age may include gait abnormalities, greater metabolic cost of movement, greater fatigability, and reduced physical activity. Collectively, these factors may contribute to greater cardiometabolic risk and weight gain, and reduced quality of life with older age. Strategies to alleviate and/or delay the progression of OA in younger and middle-aged adults are necessary to help reduce this risk.

Crocker, GH, Moon, JF, Nessler, JA, and Newcomer, SC. Energetics of swimming with hand paddles of different surface areas. J Strength Cond Res 35(1): 205-211, 2021-Hand paddles are one of the most common training aids used by the competitive swimmer, yet little is known regarding how hand paddle surface area affects the metabolic cost of transport (COT) while swimming. The purpose of this study was to determine how altering hand paddle size affects energy use during submaximal, front-crawl (i.e., freestyle) swimming. Twenty-six proficient, adult swimmers (13 men and 13 women) completed six 3-minute trials in a flume at a constant pace (102 cm·s-1; 1:38 per 100 m). Trials were performed in random order, using 1 of 5 pairs of hand paddles of different sizes or no paddles at all. Paddle surface areas were 201, 256, 310, 358, and 391 cm2 per hand. Without paddles, COT, arm cadence, and distance per stroke were 7.87 ± 1.32 J·kg-1·m-1, 29.4 ± 4.9 min-1, and 2.13 ± 0.34 m, which corresponded to a rate of oxygen consumption (Vo2) of 23.3 ± 3.7 ml·kg-1·min-1 and a heart rate (HR) of 118 ± 17 b·min-1. The use of larger hand paddles decreased COT, cadence, Vo2, and HR and increased distance traveled per stroke (all p < 0.001). However, the magnitude of the change of COT decreased as paddle size increased, indicating diminishing marginal return with increasing paddle surface area. The largest sized paddles increased COT per stroke compared with swimming without paddles (p = 0.001). Therefore, results from this study suggest that an optimal hand paddle size exists (210-358 cm2) for proficient, adult swimmers, which reduces COT without increasing COT per stroke.

Background Asymmetric gait post-stroke is associated with decreased mobility, yet individuals with chronic stroke often self-select an asymmetric gait despite being capable of walking more symmetrically. The purpose of this study was to test whether self-selected asymmetry could be explained by energy cost minimization. We hypothesized that short-term deviations from self-selected asymmetry would result in increased metabolic energy consumption, despite being associated with long-term rehabilitation benefits. Other studies have found no difference in metabolic rate across different levels of enforced asymmetry among individuals with chronic stroke, but used methods that left some uncertainty to be resolved. Methods In this study, ten individuals with chronic stroke walked on a treadmill at participant-specific speeds while voluntarily altering step length asymmetry. We included only participants with clinically relevant self-selected asymmetry who were able to significantly alter asymmetry using visual biofeedback. Conditions included targeting zero asymmetry, self-selected asymmetry, and double the self-selected asymmetry. Participants were trained with the biofeedback system in one session, and data were collected in three subsequent sessions with repeated measures. Self-selected asymmetry was consistent across sessions. A similar protocol was conducted among unimpaired participants. Results Participants with chronic stroke substantially altered step length asymmetry using biofeedback, but this did not affect metabolic rate (ANOVA, p = 0.68). In unimpaired participants, self-selected step length asymmetry was close to zero and corresponded to the lowest metabolic energy cost (ANOVA, p = 6e-4). While the symmetry of unimpaired gait may be the result of energy cost minimization, self-selected step length asymmetry in individuals with chronic stroke cannot be explained by a similar least-effort drive. Conclusions Interventions that encourage changes in step length asymmetry by manipulating metabolic energy consumption may be effective because these therapies would not have to overcome a metabolic penalty for altering asymmetry.

NEW FINDINGS What is the central question of this study? The aim was to compare the cost of transport and mechanical work between obese and non-obese children at different walking speeds. What is the main finding and its importance? Our data show that the cost of transport, mechanical efficiency and work are similar and directly mass dependent in obese and non-obese children. The optimal walking speed (most economical walking speed) is reduced in obese children. ABSTRACT Although studies have shown the influence of gait biomechanics on the metabolic economy in obese adults and adolescents, little is known regarding obese children. We compared the metabolic cost of transport, apparent mechanical efficiency and gait biomechanics (assessed by mechanical energy fluctuations) in obese children (n = 12; mean ± SD: 8.6 ± 0.51 years of age, 1.38 ± 0.04 m, 44.6 ± 6.65 kg, 24.1 ± 3.50 kg m-2 ) and age- and sex-matched non-obese children (n = 12, 7.8 ± 0.90 years of age, 1.31 ± 0.08 m, 26.8 ± 2.24 kg, 16.4 ± 1.40 kg m-2 ) while walking at different speeds (from 1 to 5 km h-1 ) on a treadmill. We found that the mechanical efficiency was higher at 3 km h-1 compared with the remaining speeds for both groups (P

Background It has been estimated that automated peritoneal dialysis (APD) is currently the fastest growing renal replacement therapy in the world. However, in light of the growing number of diabetic patients on peritoneal dialysis (PD), the unwanted glucose absorption during APD remains problematic. Recent results, using an extended 3-pore model of APD, indicated that large reductions in glucose absorption are possible by using optimized bi-modal treatment regimens, having “UF cycles” using a higher glucose concentration, and “Clearance cycles” using a low concentration or, preferentially, no glucose. The present study is designed to test the theoretical prediction of a lower glucose absorption using these novel regimes. Methods This study is a randomized single-center, open-label, prospective study. Prevalent PD patients between 18 and 75 years old without known catheter problems or recent peritonitis are eligible for inclusion. Patients are allocated to a first treatment session of either standard APD (6 × 2 L 1.36% over 9 h) or optimized APD (7 × 2 L 2.27% + 5 × 2 L 0.1% over 8 h). A second treatment session using the other treatment will be performed in a crossover fashion. Samples of the dialysis fluid will be taken before and after the treatment, and the volume of the dialysate before and after the treatment will be carefully assessed. The primary endpoint is difference in glucose absorption between the optimized and standard treatment. Secondary endpoints are ultrafiltration, sodium removal, Kt/V urea, and Kt/V Creatinine. The study will be closed when a total of 20 patients have successfully completed the interventions or terminated according to interim analysis. A Monte Carlo power analysis shows that the study has 80% power to detect a difference of 10 g (in line with that of theoretical results) in glucose absorption between the two treatments in 10 patients. Discussion The present study is the first clinical investigation of optimized bi-modal treatments proposed by recent theoretical studies. Trial registration ClinicalTrials.gov identifier: NCT04017572. Registration date: July 12, 2019, retrospectively registered.

Purpose: This systematic review is aimed at evaluating the efficacy of AFO types and comparison between them on the energy expenditure metrics of walking in individuals who had suffered a stroke with (sub)acute or chronic evolution.Methods: The following databases were searched; PubMed, Scopus, ISI Web of Knowledge, Embase and Cochrane Library based on the population intervention comparison outcome (PICO) method.Results: A total of 15 trials involving 195 participants were selected for the final evaluation. All trials, except one, examined individuals in chronic phase. Although the evidence from the selected studies was generally weak, the consensus was that an AFO may have a positive immediate effect on the energy expenditure metrics including energy cost, physiological cost index, mechanical work and vertical center of mass trajectory on the affected leg, in both overground walking and treadmill walking in adults with chronic stroke. There were insufficient studies to evaluate the medium term efficacy of wearing an AFO combined with gait training on metabolic cost parameters during ambulation. There were also insufficient studies for comparison among different designs of AFOs.Conclusions: An AFO can immediately improve energy expenditure metrics of walking in stroke survivors. There is a need for further well-designed randomized trials to evaluate long-term effect of gait training using AFOs and comparison among the different types of orthoses.IMPLICATIONS FOR REHABILITATIONAn AFO can immediately improve the energy expenditure metrics during walking after stroke.Measurement of energetic parameters of walking wearing a orthotic device such as an AFO can evaluate gait economy in stroke populations.

This study evaluated the metabolic cost and stride frequency during exercise while wearing an evenly distributed weight vest in recreationally fit women. Nine healthy women performed a modified Balke treadmill test until volitional fatigue in one of three conditions; (1) unloaded (2) rucksack and (3) weighted vest. Wearing a weighted vest did not show improvement of V̇

Nowadays, low back pain has a high incidence during the crowd who work under a long time and repeated stoop condition. Exoskeletons may form a new strategy to reduce the risk of developing low back...

Douglas, AS and Kennedy, CR. Tracking in-match movement demands using local positioning system in world-class men's ice hockey. J Strength Cond Res 34(3): 639-646, 2020-While the global positioning system has been used in field sports for a decade, local positioning systems are newly available in indoor sports for the tracking of velocity and distance during competition. World-class male ice hockey players (n = 20) were monitored during 5 international matches. Speed and distance outputs were analyzed to determine the differences between positions, periods, and in-shift demands. Defense had a difference between forwards at distances covered at very slow (p < 0.001), slow (p < 0.001), and moderate (p < 0.001) speed. Forwards were found to cover a greater distance at very fast speed (p = 0.001) and sprint speed (p < 0.001). Defense had a decrease in skating distance at very fast (p < 0.001) and sprint skating speeds (p = 0.02). Forwards had an increase in very slow skating (p = 0.02) and a decrease in sprint skating distance (p = 0.02). Game situational differences were found for defense and forwards in average speeds for defense (p < 0.001) and forwards (p < 0.001). Local positioning systems data have the potential to accurately inform coaches of the position-specific demands of game situations and the training needs by position. Specifically, forwards performed more high-intensity skating than defensemen, whereas powerplay and penalty kill situations offered specific demands for the 2 positional groups. Finally, the intensity of skating was reduced in the third period for both defensemen and forwards. Further research can evaluate whether this is related to tactical decisions, or the metabolic cost of ice hockey.

Backpacks are essential for travel but carrying a load during a long journey can easily cause muscle fatigue and joint injuries. Previous studies have suggested that suspended backpacks can effectively reduce the energy cost while carrying loads. Researchers have found that adjusting the stiffness of a suspended backpack can optimize its performance. Therefore, this paper proposes a stiffness-adjustable suspended backpack; the system stiffness can be adjusted to suitable values at different speeds. The stiffness of the suspended backpack with a 5-kg load was designed to be 690 N/m for a speed of 4.5 km/h, and it was adjusted to 870 and 1050 N/m at speeds of 5.5 and 6.5 km/h, respectively. The goal of this study was to determine how carrying a stiffness-adjustable suspended backpack affected performance while carrying a load. Six healthy participants participated in experiments where they wore two backpacks under three conditions: the adjustable-stiffness suspended backpack condition (S_A), the unadjustable-stiffness suspended backpack condition (S_UA), and the ordinary backpack condition (ORB). Our results showed that the peak accelerations, muscle activities, and peak ground reaction forces in the S_A condition were reduced effectively by adjusting the stiffness to adapt to different walking speeds; this adjustment decreased the metabolic cost by 4.21 ± 1.21% and 2.68 ± 0.88% at 5.5 km/h and 4.27 ± 1.35% and 3.38 ± 1.31% at 6.5 km/h compared to the ORB and S_UA, respectively.

Background Load carriage is common in a wide range of professions, but prolonged load carriage is associated with increased fatigue and overuse injuries. Exoskeletons could improve the quality of life of these professionals by reducing metabolic cost to combat fatigue and reducing muscle activity to prevent injuries. Current exoskeletons have reduced the metabolic cost of loaded walking by up to 22% relative to walking in the device with no assistance when assisting one or two joints. Greater metabolic reductions may be possible with optimized assistance of the entire leg. Methods We used human-in the-loop optimization to optimize hip-knee-ankle exoskeleton assistance with no additional load, a light load (15% of body weight), and a heavy load (30% of body weight) for three participants. All loads were applied through a weight vest with an attached waist belt. We measured metabolic cost, exoskeleton assistance, kinematics, and muscle activity. We performed Friedman’s tests to analyze trends across worn loads and paired t-tests to determine whether changes from the unassisted conditions to the assisted conditions were significant. Results Exoskeleton assistance reduced the metabolic cost of walking relative to walking in the device without assistance for all tested conditions. Exoskeleton assistance reduced the metabolic cost of walking by 48% with no load (p = 0.05), 41% with the light load (p = 0.01), and 43% with the heavy load (p = 0.04). The smaller metabolic reduction with the light load may be due to insufficient participant training or lack of optimizer convergence. The total applied positive power was similar for all tested conditions, and the positive knee power decreased slightly as load increased. Optimized torque timing parameters were consistent across participants and load conditions while optimized magnitude parameters varied. Conclusions Whole-leg exoskeleton assistance can reduce the metabolic cost of walking while carrying a range of loads. The consistent optimized timing parameters across participants and conditions suggest that metabolic cost reductions are sensitive to torque timing. The variable torque magnitude parameters could imply that torque magnitude should be customized to the individual, or that there is a range of useful torque magnitudes. Future work should test whether applying the load to the exoskeleton rather than the person’s torso results in larger benefits.

Neuromuscular electrical stimulation (NMES) is used to increase not only muscle strength but also whole-body metabolism. A hybrid training system (HTS) in which NMES is synchronized to voluntary exercise by an articular motion sensor may increase exercise load during aerobic walking exercise. We assessed the metabolic cost during walking exercise (5 minutes at 4 km/h and 5.6 km/h) on a treadmill simultaneously combined with HTS (HTSW) or without HTS (CON). We evaluated oxygen uptake ( VO·2) and heart rate (HR) during HTSW or CON on different days in fifteen subjects. The values ofVO·2 during HTSW at 4 km/h and 5.6 km/h were signifi cantly greater than those during CON (16.6 ± 1.85 ml/min/kg vs 15.3 ± 1.48 ml/min/kg; p < 0.05, 21.0 ± 2.17 ml/min/kg vs 19.4 ± 2.13 ml/min/kg; p < 0.01, respectively). The values of HR during HTSW at 4 km/h, 5.6 km/h were significantly greater than those during CON (106.7 ± 8.1 bpm vs 101.7 ± 10.3 bpm; p < 0.05, 126.5 ± 11.1 bpm vs 121.5 ± 12.5 bpm; p < 0.05, respectively). HTS added significantly to the exercise load by 8.3 ± 12.0% or 9.1 ± 9.9% during aerobic walking exercise at 4 km/h or 5.6 km/h, respectively. HTS might be useful for health promotion by increasing metabolic cost during aerobic walking exercise without increasing the perceived difficulty.

Powered exoskeletons are used to assist human walking, but it is inconvenient for a user to carry a bulky energy-supply system. During walking, human lower limbs accelerate and decelerate alternatively, during which period the human body does positive and negative work, respectively. Therefore, if the negative work performed during deceleration can be harnessed using some assisting device to then assist the acceleration movement of the lower limb, the total metabolic cost of the human body during walking can be reduced. In this work, an unpowered flexible lower limb exoskeleton is proposed; it is worn in parallel to the lower limbs to assist human walking without consuming external electrical power. The flexible exoskeleton imitates the physiological structure of a human lower limb, consisting of elastic and damping components. When worn on the lower limb, the exoskeleton can partly replace the function of the lower limb muscles, which can scavenge kinetic energy during lower limb deceleration to assist the acceleration movement, so that the biomechanical power consumption can be reduced during walking. In addition to the walking assistance, the generator in the exoskeleton, serving as a damping component, can harvest kinetic energy to produce electricity for powering wearable electronics. A prototype of the flexible exoskeleton was developed, and experiments were conducted to validate the effectiveness. The experiments showed that the lower limb exoskeleton could reduce the metabolic cost by 3.12% at the walking speed of 4.5 km/h, and a maximum electrical power of 6.47 W was generated at the walking speed of 5.1 km/h.

Background Understanding the cardiovascular and psychophysical demands of repetitive lifting tasks is important in job design strategies. This study determined the cardiovascular (oxygen consumption (VO2) and heart rate (HR) and psychophysical response to repetitive lifting tasks in women. Methods Ten female (age 27 ± 5 yrs) participants transferred 11.4, 15.9, and 20.5 kg weights back and forth from a rung 40.6 cm high to a rung 156.2 cm high. Rungs were 195.6 cm apart horizontally. Three, 10 minute bouts (1 = 11.4 kg; 2 = 15.9 kg; 3 = 20.5 kg) were performed at 6 lifts per minute. Cardiovascular and psychophysical (rating of perceived exertion, RPE) parameters were monitored throughout the bouts. VO2max and HRmax were determined via a maximal treadmill test. Results VO2, HR, and RPE were significantly different between each work bout (p < 0.01), with each outcome variable increasing as load increased. VO2max and HRmax equaled 46.5 ± 7.5 mL·kg−1·min−1 and 191 ± 11 bpm, respectively. Work at 11.4 kg was performed at 38% VO2max and 63% HRmax; at 15.9 kg at 41% VO2max and 72% HRmax; and at 20.5 kg at 49% VO2max and 81% HRmax. RPE at 11.4, 15.9, and 20.5 kgs were: 8.4 ± 1.6, 11.4 ± 1.9, and 15.0 ± 2.2. Conclusion During these repetitive lifting tasks, metabolic cost and perceived exertion increased with weight lifted; average work intensity ranged from 63 to 81% of HRmax and 38 to 49% of VO2max. Results have important implications in relation to job pacing and design, and worksite health promotion strategies aimed at reducing work place injury.

OBJECTIVE: To investigate the effect of timing and magnitude of horizontally directed propulsive forces to the center of mass (COM) on the metabolic cost of walking for individuals following stroke. DESIGN: Repeated measures, within-subjects design SETTING: Research laboratory PARTICIPANTS: Nine individuals with chronic hemiparesis post-stroke and seven unimpaired similarly aged controls INTERVENTION: Individuals walked on a treadmill in two separate studies. First, we compared the metabolic cost of walking with an anterior force applied to the COM that 1) coincided with paretic propulsion or 2) was applied throughout the gait cycle. Next, we compared the metabolic cost of walking with anterior (assistive) or posterior (resistive) forces applied during paretic propulsion. MAIN OUTCOME MEASURE: metabolic cost of walking RESULTS: The cost of walking was significantly greater in the Stroke group. Anterior (propulsive) assistance reduced the cost of walking differently based on group. The Stroke group exhibited a 12% reduction in cost of walking when assistance was provided only during paretic propulsion, but not when assistance was provided throughout the gait cycle. In contrast, the Control group demonstrated reduced cost of walking during both anterior assistance conditions. In addition, we observed that resistance during paretic propulsion (simulated hemiparesis for Control group) significantly increased the cost of walking. CONCLUSIONS: Systematically manipulating propulsive forces at the body’s COM had a profound influence on metabolic cost. The timing of propulsive forces to the COM are important and need to coincide with paretic terminal stance. Additional internally or externally generated propulsive forces applied to the body’s COM after stroke may produce a lower metabolic cost of walking.

The timing with which salmonid larvae emerge from their gravel nests is thought to be correlated with a particular suite of behavioural and physiological traits that correspond to the stress coping style of the individual. Among these traits, aggressiveness, dominance and resilience to stress, are potentially interesting to exploit in aquaculture production. In the present study a series of experiments were performed, with the purpose of characterising behavioural, metabolic and production related traits in rainbow trout juveniles from different emergence fractions. Newly hatched rainbow trout were sorted according to their emergence time from an artificial redd. The early, middle, and late fractions were retained and assessed for their physiological response to stress, growth performance, metabolism, fasting tolerance, and potential for compensatory growth. The early emerging fraction showed proactive behavioural traits; they were faster to reappear following startling, showed a reduced cortisol response following stress, and a reduced metabolic cost of recovery. Emergence time was not correlated with any differences in standard or maximum metabolic rates, but was however, correlated with higher routine metabolic rates, as demonstrated by significantly bigger weight losses during fasting in the early emerging group. Growth rates and feed conversion efficiencies were not significantly different when fish were co-habitated under a restrictive feeding regime, suggesting that early emerging fish are not able to monopolise food resources. The intermediate emerging group, which makes up the bulk of a population and is often ignored, appears to possess the best growth performance traits, possibly because they do not expend excessive energy on dominance behaviour such as the early emerging group, while they are also not overly timid or stress prone such as the late emerging group.

It is known that obesity is associated with biomechanical alterations during locomotor tasks, which is considered a potential risk factor for the development of musculoskeletal disorders (MSKD). However, the association of obesity with biomechanical alterations of walking in the early stages of life have not yet been systematically reviewed. Thus, this review aims to summarize the biomechanical characteristics of walking in children and adolescents with overweight/obesity (OW/OB) versus their normal-weight (NW) counterparts. PubMed and Web of Science were systematically searched until November 2018. We found strong and moderate evidence supporting biomechanical differences in the gait pattern of OW/OB with respect to NW. Based on strong evidence, the gait patterns of OW/OB present greater pelvis transversal plane motion, higher hip internal rotation, higher hip flexion, extension and abduction moments and power generation/absorption, greater knee abduction/adduction motion, and higher knee abduction/adduction moments and power generation/absorption. Based on moderate evidence, OW/OB walk with greater step width, longer stance phase, higher tibiofemoral contact forces, higher ankle plantarflexion moments and power generation, and greater gastrocnemius and soleus activation/forces. These biomechanical alterations during walking in OW/OB could play a major role in the onset and progression of MSKD. ispartof: OBESITY REVIEWS vol:20 issue:7 pages:1033-1044 ispartof: location:England status: published

Neuromuscular impairment associated with cerebral palsy (CP) often leads to life-long walking deficits. Our goal was to evaluate the ability of a novel untethered wearable ankle exoskeleton to reduce the severity of gait pathology from CP. In this clinical feasibility study of five individuals with CP, we used instrumented gait analysis to quantify how powered plantar-flexor assistance affected gait mechanics following multi-visit acclimation. Compared to how each participant walked normally, walking with untethered exoskeleton assistance resulted in improved ankle plantar-flexion and knee extension; residual flexion deformity across the lower-extremity improved by a clinically significant 14.4° (p = 0.022). Powered plantar-flexor assistance increased average total positive ankle power by 44% (p = 0.037), and resulted in a 30% reduction in average negative biological ankle power (p = 0.004) and a 29% reduction in average positive hip power (p = 0.009). These findings suggest that powered ankle assistance augmented, rather than simply replaced, biological function to produce a more efficient gait pattern, which was corroborated by a 19% improvement in metabolic cost of transport (p = 0.011). This study provides evidence in support of the continued investigation of ankle assistance in mobility and rehabilitation interventions for this patient population.

Background Persons with multiple sclerosis (pwMS) experience walking impairments, characterized by decreased walking speeds. In healthy subjects, the self-selected walking speed is the energetically most optimal. In pwMS, the energetically most optimal walking speed remains underexposed. Therefore, this review aimed to determine the relationship between walking speed and energetic cost of walking (Cw) in pwMS, compared with healthy subjects, thereby assessing the walking speed with the lowest energetic cost. As it is unclear whether the Cw in pwMS differs between overground and treadmill walking, as reported in healthy subjects, a second review aim was to compare both conditions. Method PubMed and Web of Science were systematically searched. Studies assessing pwMS, reporting walking speed (converted to meters per second), and reporting oxygen consumption were included. Study quality was assessed with a modified National Heart, Lung and Blood Institute checklist. The relationship between Cw and walking speed was calculated with a second-order polynomial function and compared between groups and conditions. Results Twenty-nine studies were included (n = 1535 pwMS) of which 8 included healthy subjects (n = 179 healthy subjects). PwMS showed a similar energetically most optimal walking speed of 1.44 m/s with a Cw of 0.16, compared with 0.14 mL O2/kg/m in healthy subjects. The most optimal walking speed in treadmill was 1.48 m/s, compared with 1.28 m/s in overground walking with a similar Cw. Conclusion Overall, the Cw is elevated in pwMS but with a similar energetically most optimal walking speed, compared with healthy subjects. Treadmill walking showed a similar most optimal Cw but a higher speed, compared with overground walking.

Loss of a lower limb below the knee, i.e., transtibial limb loss, and subsequently walking with a prosthesis, is generally thought to increase the metabolic cost of walking vs. able-bodied controls. However, high-functioning individuals with limb loss such as military service members often walk with the same metabolic cost as controls. Here we used a 3-D computer model and optimal control simulation approach to test the hypothesis that transtibial limb loss in and of itself causes an increase in metabolic cost of walking. We first generated N = 36 simulations of walking at 1.45 m/s using a “pre-limb loss” model, with two intact biological legs, that minimized deviations from able-bodied experimental walking mechanics with minimum muscular effort. We then repeated these simulations using a “post-limb loss” model, with the right leg’s ankle muscles and joints replaced with a simple model of a passive transtibial prosthesis. No other changes were made to the post-limb loss model’s remaining muscles or musculoskeletal parameters compared to the pre-limb loss case. Post-limb loss, the gait deviations on average increased by only 0.17 standard deviations from the experimental means, and metabolic cost did not increase (3.58 ± 0.10 J/m/kg pre-limb loss vs. 3.59 ± 0.12 J/m/kg post-limb loss, p = 0.65). The results suggest that transtibial limb loss does not directly lead to an increase in metabolic cost, even when deviations from able-bodied gait mechanics are minimized. High metabolic costs observed in individuals with transtibial limb loss may be due to secondary changes in strength or general fitness after limb loss, modifiable prosthesis issues, or to prioritization of factors that affect locomotor control other than gait deviations and muscular effort.

Difficulty walking in older adults affects their independence and ability to execute daily tasks in an autonomous way, which can result in a negative effect to their health status and risk of morbidity. Very often, reduced walking speed in older adults is caused by an elevated metabolic energy cost. Passive exoskeletons have been shown to offer a promising solution for lowering the energy cost of walking, and their simplicity could favor their use in real world settings. The goal of this study was to assess if a constant and consistent low torque applied by means of a passive exoskeleton to the hip flexors during walking could provide higher and more consistent metabolic cost reduction than previously achieved. Eight older adults walked on a treadmill at a constant speed of 1.1 m/s with and without the hip assistive device. Metabolic power and spatiotemporal parameters were measured during walking in these two conditions of testing. The hip assistive device was able to apply a low torque which initiates its assistive effect at mid-stance. This reduced the metabolic cost of walking across all the participants with respect to free walking (−4.2 ± 1.9%, p = 0.002). There were no differences in the spatiotemporal parameters reported. This study strengthened the evidence that passive assistive devices can be a valuable tool to reduce metabolic cost of walking in older adults. These findings highlighted the importance of investigating torque profiles to improve the performance provided by a hip assistive device. The simplicity and usability of a system of this kind can make it a suitable candidate for improving older adults’ independence.

In the past two decades, with growing focus of lower limb exoskeleton, large variety of rigid exoskeletons were designed for medical rehabilitation and the other purposes. Compared with the rigid exoskeletons, which added extra inertial to low limb and restricted wearers' movement, the soft wearable lower extremity exoskeleton minimized the impact of these factors on the human body locomotion. In this paper, a novel design of exosuit that provided assistive force for both hip extension and flexion through the variation in hip joint dynamics during strides was proposed. Based on the change of hip moment, an assistance strategy and assistance force curve were came up with. PD type iterative learning control (ILC) method was introduced to reduce the error caused by wearing position and biological characteristics to improve assistance performance. To evaluate assistance performance, the metabolic cost of four subjects wearing exosuit and walking on treadmill at 5km/h in the situations of that without assistance, assisting both hip extension and hip flexion, and assisting hip extension respectively was measured. Compared with assisting hip extension only and wearing exosuit with no assistance, results indicated that the decrease in average net metabolic cost of assisting both hip extension and flexion was 0.445W/kg and 1.027W/kg respectively, corresponding to the average net metabolic cost rate decrease was 7.45% and 15.67%.

Background Powered prosthetic ankles provide battery-powered mechanical push-off, with the aim of reducing the metabolic demands of walking for people with transtibial amputations. The efficacy of powered ankles has been shown in active, high functioning individuals with transtibial amputation, but is less clear in other populations. Additionally, it is unclear how use of a powered prosthesis influences everyday physical activity and mobility. Methods Individuals with unilateral transtibial amputations participated in a randomized clinical trial comparing their prescribed, unpowered prosthesis and the BiOM powered prosthesis. Participants’ metabolic costs and self-selected walking speeds were measured in the laboratory and daily step count, daily steps away from home, and walking speed were measured over two weeks of at-home prosthesis use. Participants also rated their perception of mobility and quality of life and provided free-form feedback. Dependent measures were compared between prostheses and the relationships between metabolic cost, perception of mobility, and characteristics of walking in daily life were explored using Pearson’s correlations. Results Twelve people were randomly allocated to the powered prosthesis first (n = 7) or unpowered prosthesis first (n = 5) and ten completed the full study. There were no differences in metabolic costs (p = 0.585), daily step count (p = 0.995), walking speed in-lab (p = 0.145) and in daily life (p = 0.226), or perception of mobility between prostheses (p ≥ 0.058). Changes varied across participants, however. There were several medium-sized effects for device comparisons. With the powered prosthesis, participants had increased self-reported ambulation (g = 0.682) and decreased frustration (g = 0.506). Conclusions There were no universal benefits of the powered prosthesis on function in the lab or home environment. However, the effects were subject-specific, with some reporting preference for power and improved mobility, and some increasing their activity and decreasing their metabolic effort. Additionally, self-reported preferences did not often correlate with objective measures of function. This highlights the need for future clinical research to include both perception and objective measures to better inform prosthetic prescription. Trial registration: https://clinicaltrials.gov, #NCT02828982. Registered 12 July 2016, https://clinicaltrials.gov/ct2/show/NCT02828982

Background Weakness of ankle and knee musculature following injury or disorder results in reduced joint motion associated with metabolically expensive gait compensations to enable limb support and advancement. However, neuromechanical coupling between the ankle and knee make it difficult to discern independent roles of these restrictions in joint motion on compensatory mechanics and metabolic penalties. Methods We sought to determine relative impacts of ankle and knee impairment on compensatory gait strategies and energetic outcomes using an unimpaired cohort (N = 15) with imposed unilateral joint range of motion restrictions as a surrogate for reduced motion resulting from gait pathology. Participants walked on a dual-belt instrumented treadmill at 0.8 m s−1 using a 3D printed ankle stay and a knee brace to systematically limit ankle motion (restricted-ank), knee motion (restricted-knee), and ankle and knee motion (restricted-a + k) simultaneously. In addition, participants walked without any ankle or knee bracing (control) and with knee bracing worn but unrestricted (braced). Results When ankle motion was restricted (restricted-ank, restricted-a + k) we observed decreased peak propulsion relative to the braced condition on the restricted limb. Reduced knee motion (restricted-knee, restricted-a + k) increased restricted limb circumduction relative to the restricted-ank condition through ipsilateral hip hiking. Interestingly, restricted limb average positive hip power increased in the restricted-ank condition but decreased in the restricted-a + k and restricted-knee conditions, suggesting that locking the knee impeded hip compensation. As expected, reduced ankle motion, either without (restricted-ank) or in addition to knee restriction (restricted-a + k) yielded significant increase in net metabolic rate when compared with the braced condition. Furthermore, the relative increase in metabolic cost was significantly larger with restricted-a + k when compared to restricted-knee condition. Conclusions Our methods allowed for the reproduction of asymmetric gait characteristics including reduced propulsive symmetry and increased circumduction. The metabolic consequences bolster the potential energetic benefit of targeting ankle function during rehabilitation. Trial registration N/A.

The objective of this study was to evaluate effects of photobiomodulation therapy (PBMT) on the 3000 m running performance (primary outcome), running economy (RE), metabolic cost and ratings of perceived exertion during running (secondary outcomes). Twenty male endurance athletes performed 4-min treadmill rectangular test at 12 km.h-1 monitored by a gas analyser. After that, PBMT or placebo in each lower limb was applied, followed performed a maximum test of 3000 m. Immediately after 3000 m test, the athletes repeated the treadmill test. Another application of PBMT/placebo was done after the treadmill test, and athletes went back to the laboratory 24 h later to repeat the treadmill test. After a 72 h interval, athletes repeated all procedures with another treatment intervention (PBMT/placebo). Athletes performed the 3000 m running test ~7s faster when treated with PBMT with similar effort score compared placebo condition. The RE remains unchanged immediately post 3000 m running test, nonetheless RE measured post-24 h improved by 5% with PBMT application without changes in metabolic cost. The PBMT pre- and post-conditioning enhanced the 3000 m running performance and improved RE 24 h following the 3000 m test. However, no changes on ratings of perceived exertion and metabolic cost with the application of PBMT.

Background This study used downhill running as a model to investigate the repeated bout effect (RBE) on neuromuscular performance, running biomechanics, and metabolic cost of running. Methods Ten healthy recreational male runners performed two 30-min bouts of downhill running (DR1 and DR2) at a –20% slope and 2.8 m/s 3 weeks apart. Neuromuscular fatigue, level running biomechanics during slow and fast running, and running economy parameters were recorded immediately before and after the downhill bouts, and at 24 h, 48 h, 72 h, 96 h, and 168 h thereafter (i.e., follow-up days). Results An RBE was confirmed by attenuated muscle soreness and serum creatine kinase rise after DR2 compared to DR1. An RBE was also observed in maximum voluntary contraction (MVC) force loss and voluntary activation where DR2 resulted in attenuated MVC force loss and voluntary activation immediately after the run and during follow-up days. The downhill running protocol significantly influenced level running biomechanics; an RBE was observed in which center of mass excursion and, therefore, lower-extremity compliance were greater during follow-up days after DR1 compared to DR2. The observed changes in level running biomechanics did not influence the energy cost of running. Conclusion This study demonstrated evidence of adaptation in neural drive as well as biomechanical changes with the RBE after DR. The higher neural drive resulted in attenuated MVC force loss after the second bout. It can be concluded that the RBE after downhill running manifests as changes to global and central fatigue parameters and running biomechanics without substantially altering the energy cost of running.

Many robotic exoskeletons for lower limb assistance aid walking by reducing energy costs. However, investigations examining stair-climbing assistance have remained limited, generally evaluating reduced activation of related muscles. This study sought to investigate how climbing assistance by a robotic exoskeleton affects energy consumption. Ten healthy young participants wearing a robotic exoskeleton that assists flexion and extension of hip and knee joints walked up nine flights of stairs twice at a self-selected speed with and without stair-climbing assistance. Metabolic cost was assessed by measuring oxygen consumption, heart rate, and the time to climb each flight of stairs. Net oxygen cost (NOC) and total heart beats (THB) were used as measures of metabolic cost, accounting for different climbing speeds. Stair-climbing assistance reduced NOC and THB by 9.3% ( P < 0.001 ) and 6.9% ( P = 0.003 ), respectively, without affecting climbing speed. Despite lack of individual optimization, assistive joint torque applied to the hip and knee joints reduced metabolic cost and cardiovascular burden of stair climbing in healthy young males. These results may be used to improve methods for stair ascent assistance.

Background The CYBERLEGs-gamma (CLs-ɣ) prosthesis has been developed to investigate the possibilities of powerful active prosthetics in restoring human gait capabilities after lower limb amputation. Objective The objective of this study was to determine the performance of the CLs-ɣ prosthesis during simulated daily activities. Methods Eight participants with a transfemoral amputation (age: 55 ± 15 years, K-level 3, registered under: NCT03376919) performed a familiarization session, an experimental session with their current prosthesis, three training sessions with the CLs-ɣ prosthesis and another experimental session with the CLs-ɣ prosthesis. Participants completed a stair-climbing-test, a timed-up-and-go-test, a sit-to stand-test, a 2-min dual-task and a 6-min treadmill walk test. Results Comparisons between the two experimental sessions showed that stride length significantly increased during walking with the CLs-ɣ prosthesis (p = .012) due to a greater step length of the amputated leg (p = .035). Although a training period with the prototype was included, preferred walking speed was significantly slower (p = .018), the metabolic cost of transport was significantly higher (p = .028) and reaction times significantly worsened (p = .012) when walking with the CLs-ɣ compared to the current prosthesis. Conclusions It can be stated that a higher physical and cognitive effort were required when wearing the CLs-ɣ prosthesis. Positive outcomes were observed regarding stride length and stair ambulation. Future prosthetics development should minimize the weight of the device and integrate customized control systems. A recommendation for future research is to include several shorter training periods or a prolonged adaptation period.

Gait training for paraplegic patients is effective in preventing various complications due to prolonged sitting. In these patients, the use of powered exoskeletal-gait-orthosis (EGO) consumes lower energy than traditional training methods using non-powered EGO, such as a reciprocating-gait-orthosis (RGO). Thus, long-term training is possible and effective in increasing the activity level of the trunk muscles. However, more than 60% of paraplegic patients have incomplete injuries with residual function, which is inversely related to the functional role of the orthosis. We hypothesized that the gait ability in incomplete paraplegia could be improved by knee joint activation, and we developed a lightweight knee-actuated EGO (KAEGO). We verified its effectiveness in one patient with an incomplete spinal cord injury by comparing the metabolic cost of transport (COT) measured by a six minute walk test to a traditional non-powered EGO. We found that with increasing assist torque to the knee joint, the COT decreased by up to 24.5%, and the gait performance, including walking speed and travel distance, significantly improved up to 37% compared to that of the non-powered EGO. Future studies should verify the KAEGO system&rsquo, s effectiveness in a larger number of patients with various injury levels.

The recent explosion of wearable electronics has led to widespread interest in harvesting human movement energy, particularly during walking, for clinical and health applications. However, the amount of energy available to harvest and the required metabolic rate for wearable energy harvesting varies across subjects. In this paper, we utilize custom energy harvesting sliding shoes to develop and evaluate multivariate linear regression models to predict metabolic rate and energy harvesting rate during overground walking outside of the lab. Subjects performed 200 m self-selected normal and fast walking trials on flat ground with custom sliding shoes. Metabolic rate was measured with a portable breathing analysis system and energy harvesting rate was measured directly from the generator on the custom sliding shoes. Model performance was determined by comparing the difference between actual and predicted metabolic and energy harvesting rates. Overall, predictive modeling closely matched the actual values, and there was no statistical difference between actual and predicted average metabolic rate or between actual and predicted average energy harvesting rate. Energy harvesting sliding shoes could potentially be used for a variety of wearable devices to reduce onboard energy storage, and these findings could serve to inform expected energy harvesting rates and associated required metabolic cost for a diverse array of medical and health applications.

Introduction: Exercise intolerance is common in cardiovascular disease and is a cardinal manifestation of heart failure with preserved ejection fraction (HFpEF). Decreased exercise capacity is often attributed to cardiac limitations, though HFpEF is increasingly recognized to be both a metabolic and a cardiovascular disorder. Hypothesis: Patients with HFpEF will have exaggerated metabolic cost of exercise initiation with associated high expenditure of hemodynamic reserve capacity. Methods: We quantified the workload-equivalent cost of initiating exercise using cardiopulmonary exercise testing in patients with HFpEF (N=184, age 62±13, 47% women, peak VO2 13.8±3.3 ml/kg/min). Individualized VO2-work rate relationships during loaded exercise were used to derive the work-equivalents required to move extremities with zero external resistance (0 watts)—termed “internal work” (IW). Standard linear regression techniques were used for comparisons. Results: In individuals with HFpEF, the internal work (42±28 W) was often a large portion of the total workload achieved. BMI accounted for the greatest variance in IW (23%), suggesting a metabolic basis for IW. Resting measures of myocardial function and biventricular filling pressures did not measurably contribute to explanatory variance in IW, suggesting a non-cardiac origin. Individuals with HFpEF in the fourth quartile of IW (76±28W) had a dramatic hemodynamic response to exercise in pulmonary capillary wedge and mean pulmonary arterial pressures. Changes in hemodynamic measurements were more modest between quartiles of IW in the submaximal ramp period following unloaded exercise. Conclusions: Internal work is a new measure that captures the metabolic cost of initiating movement. Internal work is associated with limitations in achievable external workload as well as steep early increases in cardiac filling pressures in HFpEF. Further investigation into the pathophysiology of elevated IW is needed.

Assessment of metabolic cost as a metric for human performance has expanded across various fields within the scientific, clinical, and engineering communities. As an alternative to measuring metabolic cost experimentally, musculoskeletal models incorporating metabolic cost models have been developed. However, to utilize these models for practical applications, the accuracy of their metabolic cost predictions requires improvement. Previous studies have reported the benefits of using personalized musculoskeletal models for various applications, yet no study has evaluated how model personalization affects metabolic cost estimation. This study investigated the effect of musculoskeletal model personalization on estimates of metabolic cost of transport (CoT) during post-stroke walking using three commonly used metabolic cost models. We analyzed walking data previously collected from two male stroke survivors with right-sided hemiparesis. The three metabolic cost models were implemented within three musculoskeletal modeling approaches involving different levels of personalization. The first approach used a scaled generic OpenSim model and found muscle activations via static optimization (SOGen). The second approach used a personalized electromyographic (EMG)-driven musculoskeletal model with personalized functional axes but found muscle activations via static optimization (SOCal). The third approach used the same personalized EMG-driven model but calculated muscle activations directly from EMG data (EMGCal). For each approach, the muscle activation estimates were used to calculate each subject’s CoT at different gait speeds using three metabolic cost models (Umberger et al., 2003;Bhargava et al., 2004;Umberger, 2010). The calculated CoT values were compared with published CoT data as a function of walking speed, step length asymmetry, stance time asymmetry, double support time asymmetry, and severity of motor impairment (i.e., Fugl-Meyer score). Overall, only SOCal and EMGCal with the Bhargava metabolic cost model were able to reproduce accurately published experimental trends between CoT and various clinical measures of walking asymmetry post-stroke. Tuning of the parameters in the different metabolic cost models could potentially resolve the observed CoT magnitude differences between model predictions and experimental measurements. Realistic CoT predictions may allow researchers to predict human performance, surgical outcomes, and rehabilitation outcomes reliably using computational simulations.

Marine endotherms in the polar regions face a formidable thermal challenge when swimming in cold water. Hence, they use morphological (fat, blubber) adjustment and peripheral vasoconstriction to reduce demands for heat production in water. The animals then regain normothermia when resting ashore. In the king penguin (Aptenodytes patagonicus) metabolic rate is lower in fed than in fasted individuals during subsequent rewarming on land. This has been suggested to be a consequence of diversion of blood flow to the splanchnic region in fed birds, which reduces peripheral temperatures. However, peripheral temperatures during recovery have never been investigated in birds with different nutritional status. The aim of this study was, therefore, to measure subcutaneous and abdominal temperatures during the rewarming phase on land in fasted and fed king penguins, and investigate to which extent any different rewarming were reflected in recovery metabolic rate (MRR) after long term immersion in cold water. We hypothesized that fed individuals would have a slower increase of subcutaneous temperatures compared to fasted penguins, and a correspondingly lower MRR. Subcutaneous tissues reached normothermia after 24.15 (back) and 21.36 min (flank), which was twice as fast as in the abdomen (46.82 min). However, recovery time was not affected by nutritional condition. MRR during global rewarming (4.56 ± 0.42 W kg−1) was twice as high as resting metabolic rate (RMR; 2.16 ± 0.59 W kg−1). However, MRR was not dependent on feeding status and was significantly elevated above RMR only until subcutaneous temperature had recovered. Contrary to our prediction, fed individuals did not reduce the subcutaneous circulation compared to fasted penguins and did not show any changes in MRR during subsequent recovery. It seems likely that lower metabolic rate in fed king penguins on land reported in other studies might not have been caused primarily by increased circulation to the visceral organs.

Background In the last decades, several powered ankle-foot orthoses have been developed to assist the ankle joint of their users during walking. Recent studies have shown that the effects of the assistance provided by powered ankle-foot orthoses depend on the assistive profile. In compliant actuators, the stiffness level influences the actuator’s performance. However, the effects of this parameter on the users has not been yet evaluated. The goal of this study is to assess the effects of the assistance provided by a variable stiffness ankle actuator on healthy young users. More specifically, the effect of different onset times of the push-off torque and different actuator’s stiffness levels has been investigated. Methods Eight healthy subjects walked with a unilateral powered ankle-foot orthosis in several assisted walking trials. The powered orthosis was actuated in the sagittal plane by a variable stiffness actuator. During the assisted walking trials, three different onset times of the push-off assistance and three different actuator’s stiffness levels were used. The metabolic cost of walking, lower limb muscles activation, joint kinematics, and gait parameters measured during different assisted walking trials were compared to the ones measured during normal walking and walking with the powered orthosis not providing assistance. Results This study found trends for more compliant settings of the ankle actuator resulting in bigger reductions of the metabolic cost of walking and soleus muscle activation in the stance phase during assisted walking as compared to the unassisted walking trial. In addition to this, the study found that, among the tested onset times, the earlier ones showed a trend for bigger reductions of the activation of the soleus muscle during stance, while the later ones led to a bigger reduction in the metabolic cost of walking in the assisted walking trials as compared to the unassisted condition. Conclusions This study presents a first attempt to show that, together with the assistive torque profile, also the stiffness level of a compliant ankle actuator can influence the assistive performance of a powered ankle-foot orthosis.

The design of effective rehabilitation protocols relies on the ability to accurately assess the physical condition and the rehabilitative needs of the patient. Monitoring muscle fatigue can increase the usability of rehabilitative and restorative devices as it helps avoiding premature tiring and injury of patients whose resistance is already compromised. In this study, we collected EMG and accelerometer data from one healthy subject during a 30-minute walk on treadmill to determine the variations of muscle activation, and gait acceleration patterns, which, however subtle, could be interpreted as early indicators of muscle fatigue. Results show an increasing Tibialis Anterior (TA) and decreasing Soleus (SOL) and Gastrocnemius (GASL, GASM) activation towards the end of the task as compared to the beginning, as well as increasing acceleration peaks during the middle swing phase. By following the approach outlined here we can assess the efficiency and reduction of metabolic cost achieved by an exoskeleton. Furthermore, muscle fatigue may be linked to the efficacy of gait rehabilitation, where decreased muscle fatigue across sessions possibly indicates longer retention of benefits after training and increased walking capacity. This methodology can be used to benchmark novel exoskeletons, monitor fatigue to avoid premature tiring of patients, and optimize rehabilitation therapies.