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1.
PLoS One ; 19(5): e0290912, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38739600

RESUMO

This cross-sectional study aimed to identify and validate cut-points for measuring physical activity using Axivity AX6 accelerometers positioned at the shank in older adults. Free-living physical activity was assessed in 35 adults aged 55 and older, where each participant wore a shank-mounted Axivity and a waist-mounted ActiGraph simultaneously for 72 hours. Optimized cut-points for each participant's Axivity data were determined using an optimization algorithm to align with ActiGraph results. To assess the validity between the physical activity assessments from the optimized Axivity cut-points, a leave-one-out cross-validation was conducted. Bland-Altman plots with 95% limits of agreement, intraclass correlation coefficients (ICC), and mean differences were used for comparing the systems. The results indicated good agreement between the two accelerometers when classifying sedentary behaviour (ICC = 0.85) and light physical activity (ICC = 0.80), and moderate agreement when classifying moderate physical activity (ICC = 0.67) and vigorous physical activity (ICC = 0.70). Upon removal of a significant outlier, the agreement was slightly improved for sedentary behaviour (ICC = 0.86) and light physical activity (ICC = 0.82), but substantially improved for moderate physical activity (ICC = 0.81) and vigorous physical activity (ICC = 0.96). Overall, the study successfully demonstrated the capability of the resultant cut-point model to accurately classify physical activity using Axivity AX6 sensors placed at the shank.


Assuntos
Acelerometria , Exercício Físico , Humanos , Idoso , Masculino , Feminino , Acelerometria/instrumentação , Acelerometria/métodos , Exercício Físico/fisiologia , Pessoa de Meia-Idade , Estudos Transversais , Comportamento Sedentário
2.
Transl Sports Med ; 2024: 7858835, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38654723

RESUMO

Background: The growth in participation in collegiate athletics has been accompanied by increased sport-related injuries. The complex and multifactorial nature of sports injuries highlights the importance of monitoring athletes prospectively using a novel and integrated biopsychosocial approach, as opposed to contemporary practices that silo these facets of health. Methods: Data collected over two competitive basketball seasons were used in a principal component analysis (PCA) model with the following objectives: (i) investigate whether biomechanical PCs (i.e., on-court and countermovement jump (CMJ) metrics) were correlated with psychological state across a season and (ii) explore whether subject-specific significant fluctuations could be detected using minimum detectable change statistics. Weekly CMJ (force plates) and on-court data (inertial measurement units), as well as psychological state (questionnaire) data, were collected on the female collegiate basketball team for two seasons. Results: While some relationships (n = 2) were identified between biomechanical PCs and psychological state metrics, the magnitude of these associations was weak (r = |0.18-0.19|, p < 0.05), and no other overarching associations were identified at the group level. However, post-hoc case study analysis showed subject-specific relationships that highlight the potential utility of red-flagging meaningful fluctuations from normative biomechanical and psychological patterns. Conclusion: Overall, this work demonstrates the potential of advanced analytical modeling to characterize components of and detect statistically and clinically relevant fluctuations in student-athlete performance, health, and well-being and the need for more tailored and athlete-centered monitoring practices.

3.
J Biomech ; 160: 111818, 2023 Sep 27.
Artigo em Inglês | MEDLINE | ID: mdl-37793202

RESUMO

Wearable sensors may allow research to move outside of controlled laboratory settings to be able to collect real-world data in clinical populations, such as older adults with osteoarthritis. However, the reliability of these sensors must be established across multiple out-of-lab data collections. Nine older adults with symptomatic knee arthritis wore wearable inertial sensors on their proximal tibias during an outdoor 6-minute walk test outside of a controlled laboratory setting as part of a pilot study. Reliability of the underlying waveforms, discrete peak outcomes, and spatiotemporal outcomes were assessed over four separate data collections, each approximately 1 week apart. Reliability at a different number of included strides was also assessed at 10, 20, 50, and 100 strides. The underlying waveforms and discrete peak outcome measures had good-to-excellent reliability for all axes, with lower reliability in frontal plane angular velocity axis. Spatiotemporal outcomes demonstrated excellent reliability. The inclusion of additional strides had little to no effect on reliability in most axes, but the confidence intervals generally became smaller across all axes. However, there was improvement in axes with lower (i.e., good) reliability. These data were collected in an out-of-lab setting, and the results are generally consistent with previous in-lab data collections, likely due to its semi-controlled nature. Additional out-of-laboratory research is required to investigate if these trends continue during truly free-living collections. This study provides support for increasing research conducted in out-of-lab data collections, as demonstrated by the good-to-excellent reliability of all axes.

4.
Scand J Med Sci Sports ; 33(11): 2125-2148, 2023 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-37551046

RESUMO

BACKGROUND: Lower limb biomechanics, including asymmetry, are frequently monitored to determine sport performance level and injury risk. However, contributing factors extend beyond biomechanical and asymmetry measures to include psychological, sociological, and environmental factors. Unfortunately, inadequate research has been conducted using holistic biopsychosocial models to characterize sport performance and injury risk. Therefore, this scoping review summarized the research landscape of studies concurrently assessing measures of lower limb biomechanics, asymmetry, and introspective psychological state (e.g., pain, fatigue, perceived exertion, stress, etc.) in healthy, competitive athletes. METHODS: A systematic search of MEDLINE, Embase, CINAHL, SPORTDiscus, and Web of Science Core Collections was designed and conducted in accordance with PRISMA guidelines. Fifty-one articles were included in this review. RESULTS: Significant relationships between biomechanics (k = 22 studies) or asymmetry (k = 20 studies) and introspective state were found. Increased self-reported pain was associated with decreased range of motion, strength, and increased lower limb asymmetry. Higher ratings of perceived exertion were related to increased lower limb asymmetry, self-reported muscle soreness, and worse jump performance. Few studies (k = 4) monitored athletes longitudinally throughout one or more competitive season(s). CONCLUSION: This review highlights the need for concurrent analysis of introspective, psychological state, and biomechanical asymmetry measures along with longitudinal research to understand the contributing factors to sport performance and injury risk from biopsychosocial modeling. In doing so, this framework of biopsychosocial preventive and prognostic patient-centered practices may provide an actionable means of optimizing health, well-being, and sport performance in competitive athletes.

5.
Sports Med Int Open ; 6(2): E53-E59, 2022 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-36340854

RESUMO

Jump-based asymmetry is often used as an indicator of sport performance and may be used to discern injury susceptibility. Due to task specificity, however, countermovement jump asymmetry may not be representative of on-court asymmetry. As such, we assessed the association between countermovement jump asymmetry and on-court impact asymmetry metrics (n=3, and n=4, respectively) using linear regressions (α=0.05). Fifteen female basketball athletes completed countermovement jump and on-court sessions across a competitive season. A significant negative association was found between peak landing force asymmetry and both overall and medium acceleration on-court asymmetry (b=-0.1, R 2 =0.08, p<0.001; b=-0.1, R 2 =0.11, p<0.001, respectively), as well as between peak propulsive force asymmetry and on-court medium acceleration asymmetry (b=-0.24, R 2 =0.04, p=0.01). Alternatively, both peak landing and peak propulsive force asymmetry were significantly positively associated with on-court high acceleration asymmetry (b=0.17, R 2 =0.08, p<0.001; b=0.35, R 2 =0.02, p=0.04, respectively). While some overlap may exist, countermovement jump and on-court impact asymmetry appear to be independent. Thus, sport-specific monitoring may be necessary to adequately monitor injury susceptibility using asymmetry.

6.
J Biomech ; 142: 111263, 2022 09.
Artigo em Inglês | MEDLINE | ID: mdl-36030636

RESUMO

To compare the inter-session placement reliability for researcher-placed and self-placed sensors, and to evaluate the validity and reliability of waveforms and discrete variables from researcher-placed and self-placed sensors following a previously described alignment correction algorithm. Fourteen healthy, pain-free participants underwent gait analysis over two data collection sessions. Participants self-placed an inertial sensor on their left tibia and a researcher placed one on their right tibia, before completing 10 overground walking trials. Following an axis correction from a principal component analysis-based algorithm, validity and reliability were assessed within and between days for each sensor placement type through Euclidean distances, waveforms, and discrete outcomes. The placement location of researcher-placed sensors exhibited good inter-session reliability (ICC = 0.85) in comparison to self-placed sensors (ICC = 0.55). Similarly, waveforms from researcher-placed sensors exhibited excellent validity across all variables (CMC ≥ 0.90), while self-placed sensors saw high validity for most axes with reductions in validity for mediolateral acceleration and frontal plane angular velocity. Discrete outcomes saw good to excellent reliability across both sensor placement types. A simple alignment correction algorithm for inertial sensor gait data demonstrated good to excellent validity and reliability in self-placed sensors with no additional data or measures. This method can be used to align sensors easily and effectively despite sensor placement errors during straight, level walking to improve 3D gait data outcomes in data collected with self-placed sensors.


Assuntos
Marcha , Dispositivos Eletrônicos Vestíveis , Aceleração , Humanos , Reprodutibilidade dos Testes , Caminhada
7.
Orthop J Sports Med ; 10(3): 23259671221084294, 2022 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-35387360

RESUMO

Background: Rotator cuff repair is a common orthopaedic procedure that provides pain relief for many patients, but unfortunately, an estimated 20% to 70% of repair procedures will fail. Previous research has shown that elongation (ie, retraction) of a repaired tendon is common even in patients with a repair construct that appears intact on magnetic resonance imaging. However, it is unknown how this repair tissue functions under dynamic conditions. Purpose: To quantify static retraction and maximum dynamic elongation of repair tissue after rotator cuff repair. Study Design: Case series; Level of evidence, 4. Methods: Data from 9 patients were analyzed for this study. During surgery, a 3.1-mm tantalum bead was sutured to the supraspinatus tendon, medial to the repair site. Glenohumeral kinematics were assessed at 1 week (static) and 3 months (static and during scapular-plane abduction) after surgery using a biplanar videoradiographic system. The 3-dimensional position of the bead was calculated relative to the tendon's insertion on the humerus (ie, bead-to-insertion distance). Static retraction was calculated as the change in the bead-to-insertion distance under static conditions between 1 week and 3 months after surgery, and maximum dynamic elongation was calculated as the maximal positive change in the bead-to-insertion distance during dynamic motion relative to the start of motion. The magnitudes of static retraction and maximum dynamic elongation were assessed with 1-sample t tests. Results: At 3 months after surgery, static retraction occurred in all patients by a mean of 10.0 ± 9.1 mm (P = .01 compared with no elongation). During scapular-plane abduction, maximum dynamic elongation averaged 1.4 ± 1.0 mm (P < .01 compared with no elongation). Descriptively, dynamic elongation consistently took 1 of 2 forms: an initial increase in the bead-to-insertion distance (mean, 2.0 ± 0.6 mm) before decreasing until the end of motion or an immediate and substantial decrease in the bead-to-insertion distance at the onset of motion. Conclusion: Repair tissue elongation (static retraction and maximum dynamic elongation) appeared to be a common and significant finding at 3 months after arthroscopic rotator cuff repair. Dynamic elongation of repair tissue during scapular-plane abduction exhibited 1 of 2 distinct patterns, which may suggest different patterns of supraspinatus mechanical and neuromuscular function.

8.
JSES Int ; 6(1): 62-69, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-35141678

RESUMO

BACKGROUND: Rotator cuff repair provides pain relief for many patients; however, retears are relatively common and affect approximately 20%-70% of patients after repair. Although magnetic resonance imaging (MRI) offers the ability to assess tissue characteristics such as tear size, retraction, and fatty infiltration, it provides little insight into the quality of the musculotendinous tissues the surgeon will encounter during surgery. However, shear wave elastography (SWE) could provide an indirect assessment of quality (ie, stiffness) by measuring the speed of shear waves propagating through tissue. The objective of this study was to determine the extent to which estimated shear modulus predicts repair integrity and functional outcomes 1 year after rotator cuff repair. METHODS: Thirty-three individuals scheduled to undergo arthroscopic rotator cuff repair were enrolled in this study. Before surgery, shear modulus of the supraspinatus tendon and muscle was estimated using ultrasound SWE. MRIs were obtained before and 1 year after surgery to assess tear characteristics and repair integrity, respectively. Shoulder strength, range of motion, and patient-reported pain and function were assessed before and after surgery. Functional outcomes were compared between groups and across time using a two-factor mixed model analysis of variance. Stepwise regression with model comparison was used to investigate the extent to which MRI and shear modulus predicted repair integrity and function at 1 year after surgery. RESULTS: At 1 year after surgery, 56.5% of patients had an intact repair. No significant differences were found in any demographic variable, presurgical tear characteristic, or shear modulus between patients with an intact repair and those with a recurrent tear. Compared with presurgical measures, patients in both groups demonstrated significant improvements at 1 year after surgery in pain (P < .01), self-reported function (P < .01), range of motion (P < .01), and shoulder strength (P < .01). In addition, neither presurgical MRI variables (P > .16) nor shear modulus (P > .52) was significantly different between groups at 1 year after surgery. Finally, presurgical shear modulus generally did not improve the prediction of functional outcomes above and beyond that provided by MRI variables alone (P > .22). CONCLUSION: Although SWE remains a promising modality for many clinical applications, this study found that SWE-estimated shear modulus did not predict repair integrity or functional outcomes at 1 year after surgery, nor did it add to the prediction of outcomes above and beyond that provided by traditional presurgical MRI measures of tear characteristics. Therefore, it appears that further research is needed to fully understand the clinical utility of SWE for musculoskeletal tissue and its potential use for predicting outcomes after surgical rotator cuff repair.

9.
J Orthop Res ; 40(4): 917-924, 2022 04.
Artigo em Inglês | MEDLINE | ID: mdl-34191325

RESUMO

Repair tissue healing after rotator cuff repair remains a significant clinical problem, and excessive shoulder activity after surgical repair is believed to contribute to re-tears. In contrast, small animal studies have demonstrated that complete removal of activity impairs tendon healing and have advocated for an "appropriate" level of activity, but in humans the appropriate amount of shoulder activity to enhance healing is not known. As an initial step toward understanding the relationship between postoperative shoulder activity and repair tissue healing, the objectives of this study were to assess the precision, accuracy, and feasibility of a wrist-worn triaxial accelerometer for measuring shoulder activity. Following assessments of precision (±0.002 g) and accuracy (±0.006 g), feasibility was assessed by measuring 1 week of shoulder activity in 14 rotator cuff repair patients and 8 control subjects. Shoulder activity was reported in terms of volume (mean acceleration, activity count, mean activity index, active time) and intensity (intensity gradient). Patients had significantly less volume (p ≤ .03) and intensity (p = .01) than controls. Time post-surgery was significantly associated with the volume (p ≤ .05 for mean acceleration, activity count, and mean activity index) and intensity (p = .03) of shoulder activity, but not active time (p = .08). These findings indicate this approach has the accuracy and precision necessary to continuously monitor shoulder activity with a wrist-worn sensor. The preliminary data demonstrate the ability to discriminate between healthy control subjects and patients recovering from rotator cuff repair and provide support for using a wearable sensor to monitor changes over time in shoulder activity.


Assuntos
Lesões do Manguito Rotador , Ombro , Animais , Artroscopia/métodos , Humanos , Manguito Rotador/cirurgia , Lesões do Manguito Rotador/cirurgia , Ombro/cirurgia , Resultado do Tratamento
10.
JSES Int ; 5(3): 500-506, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-34136861

RESUMO

BACKGROUND: Approximately 20-60% of rotator cuff repairs fail with higher failure rates in patients with larger or more chronic tears. Although MRI provides an objective estimate of tear size, it can only provide qualitative descriptions of tear chronicity. By contrast, ultrasound shear wave elastography (SWE) may assess tear chronicity by estimating tissue mechanical properties (ie, shear modulus). Furthermore, SWE imaging does not share many of the challenges associated with MRI (eg, high cost, risk of claustrophobia). Therefore, the objective of this study was to determine the extent to which estimated supraspinatus shear modulus is associated with conventional MRI-based measures of rotator cuff tear size and chronicity. METHODS: Shear modulus was estimated using ultrasound SWE in two regions of the supraspinatus (intramuscular tendon, muscle belly) under two contractile conditions (passive, active) in 22 participants with full-thickness rotator cuff tears. The extent to which estimated supraspinatus shear modulus is associated with conventional MRI measures of tear size and chronicity was assessed using correlation coefficients and Kruskal-Wallis tests, as appropriate. RESULTS: Estimated shear modulus was not significantly associated with anterior/posterior tear size (P > .09), tear retraction (P > .20), occupation ratio (P > .11), or fatty infiltration (P > .30) under any testing condition. DISCUSSION: Although ultrasound SWE measurements have been shown to be altered in the presence of various tendinopathies, the findings of this study suggest the utility of ultrasound SWE in this population (ie, patients with a small to medium supraspinatus rotator cuff tear) before surgical rotator cuff repair remains unclear.

11.
J Biomech ; 109: 109924, 2020 08 26.
Artigo em Inglês | MEDLINE | ID: mdl-32807327

RESUMO

The rotator cuff is theorized to contribute to force couples required to produce glenohumeral kinematics. Impairment in these force couples would theoretically result in impaired ball-and-socket kinematics. Although less frequently used than traditional kinematic descriptors (e.g., Euler angles, joint translations), helical axes are capable of identifying alterations in ball-and-socket kinematics by quantifying the variability (i.e., dispersion) in axis orientation and position during motion. Consequently, assessing glenohumeral helical dispersion may provide indirect evidence of rotator cuff function. The purpose of this exploratory study was to determine the extent to which rotator cuff pathology is associated with alterations in ball-and-socket kinematics. Fifty-one participants were classified into one of five groups based on an assessment of the supraspinatus using diagnostic imaging: asymptomatic healthy, asymptomatic tendinosis, asymptomatic partial-thickness tear, asymptomatic full-thickness tear, symptomatic full-thickness tear. Glenohumeral kinematics were quantified during coronal plane abduction using a biplane x-ray system and described using instantaneous helical axes. The degree to which glenohumeral motion coincided with ball-and-socket kinematics was described using the angular and positional dispersion about the optimal helical axis and pivot, respectively. No statistically significant difference was observed between groups in angular dispersion. However, symptomatic individuals with a full-thickness supraspinatus tear had significantly more positional dispersion than asymptomatic individuals with a healthy supraspinatus or tendinosis. These findings suggest that symptomatic individuals with a full-thickness supraspinatus tear exhibit impaired ball-and-socket kinematics, which is believed to be associated with a disruption of the glenohumeral force couples.


Assuntos
Lesões do Manguito Rotador , Articulação do Ombro , Fenômenos Biomecânicos , Humanos , Amplitude de Movimento Articular , Manguito Rotador
12.
Med Sci Sports Exerc ; 52(7): 1557-1562, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-31985578

RESUMO

The degree to which standard laboratory gait assessments accurately reflect impact loading in an outdoor running environment is currently unknown. PURPOSE: To compare tibial shock between treadmill and road marathon conditions. METHODS: One hundred ninety-two runners (men/women, 105/87; age, 44.9 ± 10.8 yr) completed a treadmill gait assessment while wearing a tibial-mounted inertial measurement unit, several days before completing a marathon race. Participants ran at 90% of their projected race speed and 30 s of tibial shock data were collected. Participants then wore the sensors during the race and tibial shock was averaged over the 12th, 23rd, and 40th kilometers. One-way analysis of covariance and correlation coefficients were used to compare vertical/resultant tibial shock between treadmill and marathon conditions. Analyses were adjusted for differences in running speed between conditions. RESULTS: A significant main effect of condition was found for mean vertical and resultant tibial shock (P < 0.001). Early in the marathon (12-km point), runners demonstrated higher mean tibial shock adjusted for speed compared with the treadmill data (vertical = +24.3% and resultant = +30.3%). Mean differences decreased across the course of the marathon. Vertical tibial shock at the 40th kilometer of the race was similar to treadmill data, and resultant shock remained higher. Vertical and resultant tibial shock were significantly correlated between treadmill and the 12th kilometer of the race (rs = 0.64-0.65, P < 0.001), with only 40% to 42% of the variance in outdoor tibial shock explained by treadmill measures. Correlations for tibial shock showed minimal changes across stages of the marathon. CONCLUSIONS: These results demonstrate that measures of impact loading in an outdoor running environment are not fully captured on a treadmill.


Assuntos
Meio Ambiente , Teste de Esforço/instrumentação , Corrida/fisiologia , Tíbia/fisiologia , Acelerometria/instrumentação , Adulto , Fenômenos Biomecânicos , Teste de Esforço/métodos , Feminino , Análise da Marcha , Humanos , Masculino , Pessoa de Meia-Idade , Estresse Mecânico , Dispositivos Eletrônicos Vestíveis
13.
Med Sci Sports Exerc ; 51(10): 2073-2079, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31525171

RESUMO

PURPOSE: Foot strike patterns (FSP) influence landing mechanics, with rearfoot strike (RFS) runners exhibiting higher impact loading than forefoot strike (FFS) runners. The few studies that included midfoot strike (MFS) runners have typically grouped them together with FFS. In addition, most running studies have been conducted in laboratories. Advances in wearable technology now allow the measurement of runners' mechanics in their natural environment. The purpose of this study was to examine the relationship between FSP and impacts across a marathon race. METHODS: A total of 222 healthy runners (119 males, 103 females; age, 44.1 ± 10.8 yr) running a marathon race were included. A treadmill assessment was undertaken to determine FSP. An ankle-mounted accelerometer recorded tibial shock (TS) over the course of the marathon. TS was compared between RFS, MFS, and FFS. Correlations between speed and impacts were examined between FSP. TS was also compared at the 10- and 40-km race points. RESULTS: RFS and MFS runners exhibited similar TS (12.24g ± 3.59g vs 11.82g ± 2.68g, P = 0.46) that was significantly higher (P < 0.001 and P < 0.01, respectively) than FFS runners (9.88g ± 2.51g). In addition, TS increased with speed for both RFS (r = 0.54, P = 0.01) and MFS (r = 0.42, P = 0.02) runners, but not FFS (r = 0.05, P = 0.83). Finally, both speed (P < 0.001) and TS (P < 0.001) were reduced between the 10- and the 40-km race points. However, when normalized for speed, TS was not different (P = 0.84). CONCLUSIONS: RFS and MFS exhibit higher TS than FFS. In addition, RFS and MFS increase TS with speed, whereas FFS do not. These results suggest that the impact loading of MFS is more like RFS than FFS. Finally, TS, when normalized for speed, is similar between the beginning and the end of the race.


Assuntos
Pé/fisiologia , Marcha/fisiologia , Resistência Física/fisiologia , Corrida/fisiologia , Acelerometria/métodos , Adulto , Fenômenos Biomecânicos , Comportamento Competitivo/fisiologia , Feminino , Monitores de Aptidão Física , Humanos , Perna (Membro)/fisiologia , Masculino , Pessoa de Meia-Idade , Tíbia/fisiologia , Suporte de Carga
14.
Gait Posture ; 62: 317-320, 2018 May.
Artigo em Inglês | MEDLINE | ID: mdl-29614463

RESUMO

BACKGROUND: As barefoot (BF) running provides important sensory information that influence landing patterns, it may also affect loading symmetry. RESEARCH QUESTION: The purpose of this investigation was to examine whether symmetry of loading in a group of injured runners would be improved in a novice, barefoot condition. METHODS: Cross-sectional design evaluating 67 injured RFS runners. Each subject ran on an instrumented treadmill, first with their habitual shod pattern and then in a BF condition with a FFS pattern, both at the same self-selected speed. Data were averaged over 10 footstrikes. Variables of interest included vertical average load rate, vertical instantaneous load rate, and resultant instantaneous load rate. Symmetry indices (SI) for full population and within quartiles were compared for each loadrate variable (P ≤ 0.05) to evaluate changes between conditions. RESULTS: On average, symmetry of loading was similar in a novice BF condition of injured runners compared with their habitual RFS shod condition. However, a subanalysis of quartiles revealed that the injured runners with the highest asymmetry (greatest SI values) displayed significantly lower asymmetry when running BF for all three loadrate measures. SIGNIFICANCE: The addition of sensory input during barefoot running only improves symmetry of loading when habitual loading is highly asymmetric.


Assuntos
Corrida/lesões , Corrida/fisiologia , Adulto , Fenômenos Biomecânicos , Estudos Transversais , Teste de Esforço , Feminino , Pé/fisiologia , Humanos , Masculino , Sapatos , Suporte de Carga
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