Soldier-relevant loads impact lower limb biomechanics during anticipated and unanticipated single-leg cutting movements

This study quantified how body borne load impacts hip and knee biomechanics during anticipated and unanticipated single-leg cutting maneuvers. Fifteen male military personnel performed a series of single-leg cutting maneuvers with three different load configurations (light, ~6 kg, medium, ~20 kg, and heavy, ~40 kg). Subject-based means of the specific lower limb biomechanical variables were submitted to repeated measures ANOVA to test the main and interaction effects of body borne load and movement type. With body borne load, stance time (P<0.001) increased, while larger hip (P=0.027) and knee flexion (P=0.004), and hip adduction (P<0.001) moments, and decreased hip (P=0.002) and knee flexion (P<0.001), and hip adduction (P=0.003) postures were evident. Further, the hip (P<0.001) and ankle (P=0.024) increased energy absorption, while the knee (P=0.020) increased energy generation with body borne load. During the unanticipated maneuvers, the hip (P=0.009) and knee (P=0.032) increased energy generation, and peak hip flexion moment (P=0.002) increased relative to the anticipated movements. With the body borne load, participants adopted biomechanical patterns that decreased their locomotive ability including larger moments and reduced flexion postures of the lower limb. During the single-leg cut, participants used greater energy absorption from the large, proximal muscles of the hip and greater energy generation from the knee with the addition of load. Participant?s performance when carrying a range of loads was not compromised by anticipation, as they did not exhibit the hip and knee kinetic and kinematic adaptations previously demonstrated when reacting to an unplanned stimulus.     

Individuals with varus thrust do not increase knee adduction when running with body borne load

Osteoarthritis (OA) is a common occupational hazard for service members. This study quantified how body borne load impacts knee biomechanics for participants who do and do not present varus thrust (range of knee adduction motion exhibited from heel strike to mid-stance (0–51%)) during over-ground running. Eighteen (9 varus thrust and 9 control) military personnel had knee biomechanics recorded when running with three load conditions (light, ∼6 kg, medium, 15% BW, and heavy, 30% BW). Subject-based means for knee biomechanics were calculated and submitted to a RM ANOVA to test the main effects and possible interactions between load and varus thrust group. The varus thrust group exhibited greater varus thrust (p = .001) and peak stance (PS, 0–100%) knee adduction (p = .009) posture compared to the control group with the light load, but not for the medium (p = .741 and p = .825) or heavy loads (p = .142 and p = .429). With the heavy load, varus thrust group reduced varus thrust (p = .023), whereas, the control group increased varus thrust (p = .037) compared to the light load, and increased PS knee adduction moment compared to light (p = .006) and medium loads (p = .031). The varus thrust group, however, exhibited no significant difference in knee adduction moment between any load (p = .174). With the addition of body borne load, varus thrust participants exhibited a significant reduction in knee biomechanics related to OA; whereas, control participants adopted knee biomechanics, including greater varus thrust and knee adduction moment, related to the development of OA.     

Backpack load affects lower limb muscle activity patterns of female hikers during prolonged load carriage

This study investigated the effect of prolonged load carriage on lower limb muscle activity displayed by female recreational hikers. Electromyography (EMG) signals from vastus lateralis (VL), biceps femoris (BF), semitendinosus (ST), tibialis anterior (TA) and gastrocnemius (GM) were recorded for fifteen female hikers carrying four loads (0%, 20%, 30% and 40% body weight (BW)) over 8 km. Muscle burst duration, muscle burst onset relative to initial contact and integrated EMG signals (iEMG) were calculated to evaluate muscle activity, whereas the shift in mean power frequency (MPF) was used to evaluate muscle fatigue. Increased walking distance significantly decreased the MPF of TA; decreased the iEMG for VL, ST and GM; and shortened VL muscle burst duration. Furthermore, carrying 20–40% BW loads significantly increased VL and GM iEMG and increased BF muscle burst duration, whereas a 40% BW load caused a later VL muscle burst onset. The differences observed in muscle activity with increased load mass seem to be adjustments aimed at maintaining balance and attenuating the increased loads placed on the lower limbs during gait. Based on the changes in muscle activity, a backpack load limit of 30% BW may reduce the risk of lower limb injury for female hikers during prolonged walking.     

Sex and stride length impact leg stiffness and ground reaction forces when running with body borne load

This study quantified leg stiffness and vGRF measures for males and females using different stride lengths to run with four body borne loads (20, 25, 30, and 35 kg). Thirty-six participants (20 males and 16 females) ran at 4.0 m/s using either: their preferred stride length (PSL), or strides 15% longer (LSL) and shorter (SSL) than PSL. Leg stiffness and vGRF measures, including peak vGRF, impact peak and loading rate, were submitted to a RM ANOVA to test the main effect and interactions of load, stride length, and sex. Leg stiffness was greater with the 30 kg (p = 0.016) and 35 kg (p < 0.001) compared to the 20 kg load, but decreased as stride lengthened from SSL to PSL (p < 0.001) and PSL to LSL (p < 0.001). Males exhibited greater leg stiffness than females with SSL (p = 0.029). Yet, males decreased leg stiffness with each increase in stride length (p < 0.001; p < 0.001), while females only decreased leg stiffness between PSL and LSL (p = 0.014). Peak vGRF was greater with the addition of body borne load (p < 0.001) and increase in stride length (p < 0.001). Both impact peak and loading rate were greater with the 30 kg (p = 0.034; p = 0.043) and 35 kg (p = 0.004; p = 0.015) compared to the 20 kg load, and increased as stride lengthened from SSL to PSL (p = 0.001; p = 0.004) and PSL to LSL (p < 0.001; p < 0.001). Running with body borne load may elevate injury risk by increasing leg stiffness and vGRFs. Injury risk may further increase when using longer strides to run with body borne load.     

The effect of an on-body assistive device on transverse plane trunk coordination during a load carriage task

Load carriage is a physically demanding task that is often required of employees in many different occupations. The Mover's Assistive Device (MAD) is an on-body ergonomic assistive device designed to help professional movers transfer boxes during two techniques of hand-held load carriage: anterior carriage and posterior carriage. The purpose of this study was to examine the intersegment coordination between the trunk and pelvis as well as the trunk and box, since coordination may be a mechanism to reduce the amount of stress exerted on the back during load carriage. Thirteen males completed a hand-held load carriage task in a laboratory setting using two popular techniques employed by professional movers (anterior/posterior), with and without the assistance of the Mover's Assistive Device (MAD); resulting in a total of four conditions. Triads of retro-reflective markers tracked the angular positions of the trunk, pelvis and the load being carried. Intersegment coordination between the trunk-pelvis and the box-trunk were measured using continuous relative phase angles in the transverse plane of motion. No trunk coordination differences were observed across carrying techniques (anterior/posterior); however, under all conditions users walked with a near in-phase coordination pattern, which is believed to help reduce the risk of injury. MAD use resulted in decreased perceived discomfort and more in-phase coordination between the trunk-pelvis, which may help reduce injury risk when carrying loads either anteriorly or posteriorly.     

Lower-limb joint work and power are modulated during load carriage based on load configuration and walking speed

Soldiers regularly transport loads weighing >20 kg at slow speeds for long durations. These tasks elicit high energetic costs through increased positive work generated by knee and ankle muscles, which may increase risk of muscular fatigue and decrease combat readiness. This study aimed to determine how modifying where load is borne changes lower-limb joint mechanical work production, and if load magnitude and/or walking speed also affect work production. Twenty Australian soldiers participated, donning a total of 12 body armor variations: six different body armor systems (one standard-issue, two commercially available [cARM1-2], and three prototypes [pARM1-3]), each worn with two different load magnitudes (15 and 30 kg). For each armor variation, participants completed treadmill walking at two speeds (1.51 and 1.83 m/s). Three-dimensional motion capture and force plate data were acquired and used to estimate joint angles and moments from inverse kinematics and dynamics, respectively. Subsequently, hip, knee, and ankle joint work and power were computed and compared between armor types and walking speeds. Positive joint work over the stance phase significantly increased with walking speed and carried load, accompanied by 2.3–2.6% shifts in total positive work production from the ankle to the hip (p < 0.05). Compared to using cARM1 with 15 kg carried load, carrying 30 kg resulted in significantly greater hip contribution to total lower-limb positive work, while knee and ankle work decreased. Substantial increases in hip joint contributions to total lower-limb positive work that occur with increases in walking speed and load magnitude highlight the importance of hip musculature to load carriage walking.     

Speed,age, sex,and body mass index provide a rigorous basis for comparing the kinematic and kinetic profiles of the lower extremity during walking

The increased use of gait analysis has raised the need for a better understanding of how walking speed and demographic variations influence asymptomatic gait. Previous analyses mainly reported relationships between subsets of gait features and demographic measures, rendering it difficult to assess whether gait features are affected by walking speed or other demographic measures. The purpose of this study was to conduct a comprehensive analysis of the kinematic and kinetic profiles during ambulation that tests for the effect of walking speed in parallel to the effects of age, sex, and body mass index. This was accomplished by recruiting a population of 121 asymptomatic subjects and analyzing characteristic 3-dimensional kinematic and kinetic features at the ankle, knee, hip, and pelvis during walking trials at slow, normal, and fast speeds. Mixed effects linear regression models were used to identify how each of 78 discrete gait features is affected by variations in walking speed, age, sex, and body mass index. As expected, nearly every feature was associated with variations in walking speed. Several features were also affected by variations in demographic measures, including age affecting sagittal-plane knee kinematics, body mass index affecting sagittal-plane pelvis and hip kinematics, body mass index affecting frontal-plane knee kinematics and kinetics, and sex affecting frontal-plane kinematics at the pelvis, hip, and knee. These results could aid in the design of future studies, as well as clarify how walking speed, age, sex, and body mass index may act as potential confounders in studies with small populations or in populations with insufficient demographic variations for thorough statistical analyses.     

Gait biomechanics in individuals with patellar tendon and hamstring tendon anterior cruciate ligament reconstruction grafts

Anterior cruciate ligament reconstruction (ACLR) restores joint stability following ACL injury but does not attenuate the heightened risk of developing knee osteoarthritis. Additionally, patellar tendon (PT) grafts incur a greater risk of osteoarthritis compared to hamstring grafts (HT). Aberrant gait biomechanics, including greater loading rates (i.e. impulsive loading), are linked to the development of knee osteoarthritis. However, the role of graft selection on walking gait biomechanics linked to osteoarthritis is poorly understood, thus the purpose of this study was to compare walking gait biomechanics between individuals with HT and PT grafts. Ninety-eight (74 PT; 24 HT) subjects with a history of ACLR performed walking gait at a self-selected speed from which the peak vertical ground reaction force (vGRF) during the first 50% of the stance phase and its instantaneous loading rate, peak internal knee extension and valgus moments, and peak knee flexion and varus angles were obtained. When controlling for time since ACLR and quadriceps strength, there were no differences in any kinetic or kinematic variables between graft types. While not significant, 44% of the PT cohort were identified as impulsive loaders (displaying a heelstrike transient in the majority of walking trials) compared to only 25% of the HT cohort (odds ratio = 2.3). This more frequent observation of impulsive loading may contribute to the greater risk of osteoarthritis with PT grafts. Future research is necessary to determine if impulsive loading and small magnitude differences between graft types contribute to osteoarthritis risk when extrapolated over thousands of steps per day.     

Orthoses posted in both the forefoot and rearfoot reduce moments and angular impulses on lower extremity joints during walking

The purpose of the present study was to determine the effects of orthoses designed to support the forefoot and rearfoot on the kinematics and kinetics of the lower extremity joints during walking. Fifteen participants volunteered for this study. Kinematic and kinetic variables during overground walking were compared with the participants wearing sandals without orthoses or sandals with orthoses. Orthoses increased knee internal abduction moment during late stance and knee abduction angular impulse, and reduced the medial ground reaction force during late stance, adduction free moment, forefoot eversion angle, ankle inversion moment and angular impulse, hip adduction angle, hip abduction moment, and hip external rotation moment and angular impulse (p<0.05). Orthoses decreased the torsional forces on the lower extremity and reduced the loading at the hip during walking. These findings combined with our previous studies and those of others suggest that forefoot abnormalities are critically important in influencing lower extremity kinematics and kinetics, and may underlie some non-traumatic lower extremity injuries.     

Trunk and lower limb coordination during lifting in people with and without chronic low back pain

Differences in synchronous movement between the trunk and lower limb during lifting have been reported in chronic low back pain (CLBP) patients compared to healthy people. However, the relationship between movement coordination and disability in CLBP patients has not been investigated. A cross-sectional study was conducted to compare regional lumbar and lower limb coordination between CLBP (n = 43) and control (n = 29) groups. The CLBP group was divided into high- and low-disability groups based on their Oswestry Disability Index (ODI) score. The mean absolute relative phase (MARP) angles and mean deviation phase (DP) between the (1) lumbar spine and hip, and (2) hip and knee were measured. The relationship between MARP angle and DP and ODI were investigated using linear regression. The higher-disability CLBP group demonstrated significantly greater lumbar-hip MARP angles than the lower-disability CLBP group (mean difference = 12.97, % difference = 36, p = 0.041, 95% CI [2.97, 22.98]). The higher-disability CLBP group demonstrated significantly smaller hip-knee DP than controls (mean difference = 0.11, % difference = 76, p = 0.011, 95% CI [0.03, 0.19]). There were no significant differences in lumbar-hip and hip-knee MARP and DP between the lower-disability CLBP and control groups. Lumbar-hip MARP was positively associated with ODI (R² = 0.092, β = 0.30, p = 0.048). High-disability CLBP patients demonstrated decreased lumbar-hip movement coordination and stiffer hip-knee movement during lifting than low-disability CLBP patients and healthy controls.     

Differential shock transmission response of the human body to impact severity and lower limb posture

The shocks imparted to the foot during locomotion may lead to joint-degenerative diseases and jeopardize the visual-vestibular functions. The body relies upon several mechanisms and structures that have unique viscoelastic properties for shock attenuation. The purpose of the present study was to determine whether impact severity and initial knee angle (IKA) could alter the shock transmission characteristics of the body. Impacts were administered to the right foot of 38 subjects with a human pendulum device. Combinations of velocities (0.9, 1.05 and 1.2 m s⁻¹) and surfaces (soft and hard foams) served to manipulate impact severity in the first experiment. Three IKA (0, 20 and 40°) were examined in the second experiment. Transmission between shank and head was characterized by measuring the shock at these sites with miniature accelerometers. Velocity and surface had no effect on the frequency profile of shock transmission suggesting a consistent response of the body to impact severity. Shank shock power spectrum features accounted for the lower shock ratio (head/shank) measured under the hard surface condition. IKA flexion caused considerable reduction in effective axial stiffness of the body (EASB), 28.7–7.9 kNm⁻¹, which improved shock attenuation. The high correlation (r=0.97) between EASB and shock ratio underscored the importance of EASB to shock attenuation. The present findings provide valuable information for the development of strategies aimed at protecting the joints, articular cartilage, spine and head against locomotor shock.     

Kinematic,kinetic and electromyographic differences between young adults with and without chronic ankle instability during walking

The objective of this study was to quantify the kinematic, kinetic and electromyography differences between individuals with and without chronic ankle instability (CAI) during comfortable (CW) and fast (FW) walking. Twenty-one individuals with CAI and 21 healthy controls were recruited to walk at CW and FW speeds. The dependent variables were gluteus medius, vastus lateralis, gastrocnemius lateralis, gastrocnemius medialis, peroneus longus and tibialis anterior muscles mean activity, ankle and knee angles and moments. Kinematic, kinetic and electromyography variables were compared between groups with a one-dimensional statistical non-parametric mapping analysis. The CAI group exhibited no significant difference for ankle angles and moments compared to the control group. However, the CAI group showed less external knee rotation from 56 to 100% (CW) and 51 to 98% (FW) and more knee abduction moment from 1 to 6% and 7 to 9% (CW) and 1 to 2% (FW) of the stance phase. Less gluteus medius muscle activity was also observed from 6 to 9% and 99 to 100% (CW) of the stance phase for the CAI group. These results suggest proximal biomechanical compensations and will help better understand the underlying deficits associated with CAI. They also indicate that regardless of walking speeds, individuals with CAI exhibit similar differences compared to healthy participants.     

Energy expenditure during flight in relation to body mass: effects of natural increases in mass and artificial load in Rose Coloured Starlings

Rose Coloured Starlings (Sturnus roseus) flew repeatedly for several hours in a wind tunnel while undergoing spontaneous variation in body mass. The treatments were as follows: flying unrestrained (U), with a control harness of 1.2% of their body mass (C), or with a harness of 7.4% of their body mass, which was either applied immediately before the flight (LS) or at least 9 days in advance (LL). Energy expenditure during flight (ef in W) was measured with the Doubly Labelled Water method. Flight costs in L(S) and LL were not significantly different and therefore were pooled (L). The harness itself did not affect ef, i.e. U and C flights were not different. ef was allometrically related with body mass m (in g). The slopes were not significantly different between the treatments, but ef was increased by 5.4% in L compared to C flights (log10(ef) = 0.050 + 0.47 x log10(m) for C, and log10(ef) = 0.073 + 0.47 x log10(m) for L). The difference in ef between C, LS and LL was best explained by taking the transported mass m transp (in g) instead of m into account (log10(ef) = -0.08 + 0.54 x log10(m transp)). Flight costs increased to a lesser extent than expected from interspecific allometric comparison or aerodynamic theory, regardless of whether the increase in mass occurred naturally or artificially. We did not observe an effect of treatment on breast muscle size and wingbeat frequency. We propose that the relatively low costs at a high mass are rather a consequence of immediate adjustments in physiology and/or flight behaviour than of long-term adaptations.     

Assessment of the lower limb soft tissue artefact at marker-cluster level with a high-density marker set during walking

The estimation of joint kinematics from skin markers is hindered by the soft tissue artefact (STA), a well-known phenomenon although not fully characterized. While most assessments of the STA have been performed based on the individual skin markers displacements, recent assessments were based on the marker-cluster geometrical transformations using, e.g., principal component or modal analysis. However, these marker-clusters were generally made of 4–6 markers and the current findings on the STA could have been biased by the limited number of skin makers analysed. The objective of the present study was therefore to confirm them with a high-density marker set, i.e. 40 markers placed on the segments.A larger number of modes than found in the literature was required to describe the STA. Nevertheless, translations and rotations of the marker-cluster remained the main STA modes, archetypally the translation along the proximal-distal and anterior-posterior axes for the shank and the translation along the proximal-distal axis and the rotation about the medial-lateral axis for the thigh. High correlations were also found between the knee flexion angle and the amplitude of these modes for the thigh whereas moderate ones were found for the shank.These findings support the current re-orientation of the STA compensation methods, from bone pose estimators which typically address the non-rigid components of the marker-cluster to kinematic-driven rigid-component STA models.     

Mechanical efficiency during a cycling test is not lower in children with excess body weight and low aerobic fitness

Objective:

The aims of this study were to assess the association between (i) body weight status and mechanical efficiency (ME); and (ii) ME and aerobic fitness in children aged 8‐10 years.

Design and Methods:

The sample included 464 prepubertal children (258 boys). A total of 288 were normal‐weight (NW); 84 overweight (OW); and 92 obese (OB). Subjects performed an incremental maximal cycling test with indirect calorimetry. MEcrude (%) was calculated for the first five stages of the protocol (25, 50, 75, 100, and 125 W) as follows: work produced, in watts total energy consumption, in watts^?1·100^?1. For MEnet, resting energy consumption was subtracted from total energy consumption. Energy consumption was calculated as follows: (4.94·respiratory exchange ratio + 16.04) · VO₂, in ml·min^?1·60^?1.

Results:

MEcrude was significantly higher in NW compared to OW and OB children and in OW compared to OB children at 25, 50, 75, 100, and 125 W. In contrast, MEnet did not differ significantly among NW, OW, and OB children. No statistically significant association was found between crude or net ME and peak oxygen consumption (VO₂peak; in ml·kg^?1·min^?1); therefore, the ability to transfer chemical energy to mechanical work is maintained in children aged 8‐10 years old regardless of body weight status and aerobic fitness. Moreover, higher values of MEcrude during exercise are explained by elevated oxygen consumption at rest and not by energy consumed during physical activity.

Conclusions:

These results highlight that prepubertal children are equally efficient since they are able to perform a physical task such as cycling using the same proportion of energy regardless of their body weight status.

     

Haemodynamics of leg veins during a 30-days-6 degrees head-down bedrest with and without lower body negative pressure

Venous distensibility of the lower limbs was assessed in six healthy men who were submitted twice successively to 1 month of -6 degrees head-down bedrest, with and without lower body negative pressure (LBNP) (LBNP subjects and control subjects, respectively). Venous capacity (delta Vv,max, in ml.100 ml-1) of the legs was determined by mercury strain gauge plethysmography with venous occlusion. Plethysmographic measurements were made on each subject before (Dc), during (D6 and D20) and after (5th day of recovery, D+5) bedrest. During bedrest, LBNP was applied daily, several times a day to the subjects submitted to this procedure. Results showed a gradual increase in Vv,max (ml.100 ml-1) throughout the bedrest, both in the control group [delta Vv,max = 2.11 SD 0.54 at Dc, 2.69 SD 0.29 at D6, 4.39 SD 2.08 at D20, 2.39 SD 0.69 at D+5, P less than 0.001 (ANOVA)] and in the LBNP group [delta Vv,max = 2.07 SD 0.71 at Dc, 2.85 SD 1.19 at D6, 3.75 SD 1.74 at D20, 2.43 SD 0.94 at D+5, P less than 0.001 (ANOVA)], without significant LBNP effect. These increases were of the same order as those encountered during spaceflight. It is concluded that -6 degrees head-down bedrest is a good model to simulate the haemodynamic changes induced by exposure to weightlessness and that LBNP did not seem to be a good technique to counteract the adverse effects of weightlessness on the capacitance vessels of the lower limbs. This latter conclusion raises the question of the role and magnitude of leg venous capacitance in venous return and cardiac regulation.     

Agreement between spatiotemporal parameters from a photoelectric system with different filter settings and high-speed video analysis during running on a treadmill at comfortable velocity

The aim of this study was to determine the level of agreement between spatiotemporal gait characteristics from a photoelectric system with different filter settings and high-speed video analysis during running on a treadmill at comfortable velocity. Forty-nine runners performed a running protocol on a treadmill at comfortable velocity. Two systems were used to determine spatiotemporal parameters (i.e. contact time [CT], flight time [FT], step frequency [SF] and step length [SL]) during running: OptoGait system and high-speed video analysis at 1000 Hz. The collected data was re-filtered in the OptoGait software by using nine different settings (i.e. 0_0, 1_1, 2_2, 3_3, 3_4, 4_4, 4_5, 5_4 and 5_5), and compared to those obtained through video analysis. The Pearson correlation analysis revealed very large correlations (r > 0.9, p < 0.001) in CT, FT, SF and SL between both systems, regardless of the OptoGait’s filter settings. The ICC reported an almost perfect association (ICC > 0.9) for both SL and SF regardless of the filter setting. However, large variations between filter settings according to the data from video analysis were reported in CT and FT (0_0, 1_1 and 2_2 filter settings obtained an association ICC > 0.9, whereas other filters obtained lower ICCs). Bland-Altman plots revealed small bias and error and no presence of heteroscedasticity of error for 1_1 setting. In conclusion, the filter setting for the OptoGait system should be considered to minimize the bias and error of spatiotemporal parameters measurement. For running on a treadmill, the 1_1 filter setting is recommended if gait parameters are to be compared to a high-speed video analysis (1000 Hz).     

A study of passive weight-bearing lower limb exercise effects on local muscles and whole body oxidative metabolism: a comparison with simulated horse riding,bicycle, and walking exercise

Background

We have developed an exercise machine prototype for increasing exercise intensity by means of passively exercising lower limb muscles. The purpose of the present study was to compare the passive exercise intensity of our newly-developed machine with the intensities of different types of exercises. We also attempted to measure muscle activity to study how these forms of exercise affected individual parts of the body.

Methods

Subjects were 14 healthy men with the following demographics: age 30 years, height 171.5 cm, weight 68.3 kg. They performed 4 types of exercise: Passive weight-bearing lower limb exercise (PWLLE), Simulated horse riding exercise (SHRE), Bicycle exercise, and Walking exercise, as described below at an interval of one week or longer. Oxygen uptake, blood pressure, heart rate, and electromyogram (EMG) were measured or recorded during exercise. At rest prior to exercise and immediately after the end of each exercise intensity, the oxygenated hemoglobin levels of the lower limb muscles were measured by near-infrared spectroscopy to calculate the rate of decline. This rate of decline was obtained immediately after exercise as well as at rest to calculate oxygen consumption of the lower limb muscles as expressed as a ratio of a post-exercise rate of decline to a resting one.

Results

The heart rate and oxygen uptake observed in PWLLE during maximal intensity were comparable to that of a 20-watt bicycle exercise or 2 km/hr walking exercise. Maximal intensity PWLLE was found to provoke muscle activity comparable to an 80-watt bicycle or 6 km/hr walking exercise. As was the case with the EMG results, during maximal intensity PWLLE, the rectus femoris muscle consumed oxygen in amounts identical to that of an 80-watt bicycle or a 6 km/hr walking exercise.

Conclusion

Passive weight-bearing lower limb exercise using our trial machine could provide approximately 3 MET of exercise and the thigh exhibited muscle activity equivalent to that of 80-watt bicycle or 6 km/hr walking exercise. Namely, given the same oxygen uptake, PWLLE exceeded bicycle or walking exercise in muscle activity, thus PWLLE is believed to strengthen muscle power while reducing the load imposed on the cardiopulmonary system.

     

The impact of diabetic neuropathy on the distal versus proximal comparison of weakness in lower and upper limb muscles of patients with type 2 diabetes mellitus: a cross-sectional study

Objectives:This study aimed to determine the impact of diabetic neuropathy (dNP) on the distal versus proximal comparison of weakness in lower and upper limb muscles of patients with type 2 Diabetes Mellitus (T2DM).Methods:19 healthy male controls without neuropathy (HC) and 35 male T2DM patients, without dNP (n=8), with sensory dNP (n=13) or with sensorimotor dNP (dNPsm; n=14), were enrolled in this study. Maximal isometric (IM) and isokinetic (IK) muscle strength and IK muscle endurance of the dominant knee, ankle and elbow, and maximal IM handgrip strength were measured by means of dynamometry.Results:Ankle muscle endurance was lower compared to the knee, independently of dNP (p<0.001). Maximal IK ankle muscle strength was also lower compared to the knee, albeit only in dNPsm (p=0.003). No differences were found between maximal IM handgrip and elbow strength.Conclusions:Our results suggest an impact of T2DM -with or without dNP- on lower limb muscle strength more distally than proximally, while this was not observed in the upper limb. The gradient of dNP seemed to be a determining factor for the maximal muscle strength, and not for muscle endurance, in the lower limb.