Raw Acceleration from Wrist- and Hip-Worn Accelerometers Corresponds with Mechanical Loading in Children and Adolescents.

The purpose of this study was to investigate associations between peak magnitudes of raw acceleration (g) from wrist- and hip-worn accelerometers and ground reaction force (GRF) variables in a large sample of children and adolescents. A total of 269 participants (127 boys, 142 girls; age: 12.3 ± 2.0 yr) performed walking, running, jumping (<5 cm; >5 cm) and single-leg hopping on a force plate. A GENEActiv accelerometer was worn on the left wrist, and an Actigraph GT3X+ was worn on the right wrist and hip throughout. Mixed-effects linear regression was used to assess the relationships between peak magnitudes of raw acceleration and loading. Raw acceleration from both wrist and hip-worn accelerometers was strongly and significantly associated with loading (all p's < 0.05). Body mass and maturity status (pre/post-PHV) were also significantly associated with loading, whereas age, sex and height were not identified as significant predictors. The final models for the GENEActiv wrist, Actigraph wrist and Actigraph hip explained 81.1%, 81.9% and 79.9% of the variation in loading, respectively. This study demonstrates that wrist- and hip-worn accelerometers that output raw acceleration are appropriate for use to monitor the loading exerted on the skeleton and are able to detect short bursts of high-intensity activity that are pertinent to bone health.

Assessments performed on harder surfaces can misrepresent ACL injury risk.

Changes in surface hardness are likely to alter an athlete's movement strategy. Anterior cruciate ligament (ACL) injury risk assessments that are performed on a different surface to that used for training and competition may, therefore, not represent an athlete's on-field movement strategies. The aim of this study was to examine the influence of surface hardness on multidirectional field sport athletes' movement strategies in movements that are commonly used in ACL injury risk assessments (bilateral and unilateral drop jumps, and a cutting manoeuvre). Ground reaction forcesand three-dimensional lower limb kinematics were recorded from 19 healthy, male, multidirectional field sport athletes performing bilateral and unilateral drop jumps, and a 90° cutting task on Mondo track (harder surface) and artificial turf (softer surface). Continuous (statistical parametric mapping) and discrete analyses revealed alterations in vertical and horizontal braking forces and knee and hip moments between surfaces of different hardness in all three movements (p ≤ 0.05, d > 0.5). Injury risk assessments performed on a harder surface (e.g. Mondo track) can misrepresent an athlete's risk of ACL injury compared to the same movements performed on a softer more cushioned surface that is typically used for training and/or matches (e.g. artificial turf).

Angular Velocities and Linear Accelerations Derived from Inertial Measurement Units Can Be Used as Proxy Measures of Knee Variables Associated with ACL Injury.

Given the high rates of both primary and secondary anterior cruciate ligament (ACL) injuries in multidirectional field sports, there is a need to develop easily accessible methods for practitioners to monitor ACL injury risk. Field-based methods to assess knee variables associated with ACL injury are of particular interest to practitioners for monitoring injury risk in applied sports settings. Knee variables or proxy measures derived from wearable inertial measurement units (IMUs) may thus provide a powerful tool for efficient injury risk management. Therefore, the aim of this study was to identify whether there were correlations between laboratory-derived knee variables (knee range of motion (RoM), change in knee moment, and knee stiffness) and metrics derived from IMUs (angular velocities and accelerations) placed on the tibia and thigh, across a range of movements performed in practitioner assessments used to monitor ACL injury risk. Ground reaction forces, three-dimensional kinematics, and triaxial IMU data were recorded from nineteen healthy male participants performing bilateral and unilateral drop jumps, and a 90° cutting task. Spearman's correlations were used to examine the correlations between knee variables and IMU-derived metrics. A significant strong positive correlation was observed between knee RoM and the area under the tibia angular velocity curve in all movements. Significant strong correlations were also observed in the unilateral drop jump between knee RoM, change in knee moment, and knee stiffness, and the area under the tibia acceleration curve (rs = 0.776, rs = -0.712, and rs = -0.765, respectively). A significant moderate correlation was observed between both knee RoM and knee stiffness, and the area under the thigh angular velocity curve (rs = 0.682 and rs = -0.641, respectively). The findings from this study suggest that it may be feasible to use IMU-derived angular velocities and acceleration measurements as proxy measures of knee variables in movements included in practitioner assessments used to monitor ACL injury risk.

A comparison of the associations between bone health and three different intensities of accelerometer-derived habitual physical activity in children and adolescents: a systematic review.

Positive associations have been identified between bone outcomes and accelerometer-derived moderate (MPA) and vigorous (VPA) physical activity (PA) in youth; however, it remains unclear which intensity is most beneficial. This systematic review aimed to summarise accelerometer-derived methods used to estimate habitual PA in children and adolescents and determine whether the magnitude of association was consistently stronger for a particular intensity (MPA/MVPA/VPA). Observational studies assessing associations between accelerometer-derived MPA and/or MVPA and VPA with bone outcomes in children and adolescents (≤ 18 years) were identified in MEDLINE, EMBASE, Web of Science, SPORTDiscus and the Cochrane Central Register of Controlled Trials. Thirty articles were included (total n = 20,613 (10,077 males), 4-18 years). Chi-square tests determined whether the proportion of significant associations and strongest within-study associations differed significantly between intensities. Results demonstrated that accelerometer methods were highly variable between studies. Of the 570 associations analysed, 186 were significant (p < 0.05). The proportion of within-study strongest associations differed by PA intensity (3 × 2 χ2 = 86.6, p < 0.001) and was significantly higher for VPA (39%) compared to MVPA (5%; 2 × 2 χ2 = 55.3, p < 0.001) and MPA (9%, 2 × 2 χ2 = 49.1, p < 0.001). Results indicated a greater benefit of VPA over MPA/MVPA; however, variability in accelerometer-derived methods used prevents the precise bone-benefitting amount of VPA from being identified. Long epochs and numerous intensity cut-point definitions mean that bone-relevant PA has likely been missed or misclassified in this population. Future research should explore the use of shorter epochs (1 s) and identify bone-specific activity intensities, rather than using pre-defined activity classifications more relevant to cardiovascular health.

Movement strategy correspondence across jumping and cutting tasks after anterior cruciate ligament reconstruction.

There are currently a multitude of tests used to assess readiness to return to sport (RTS) following anterior cruciate ligament reconstruction (ACLR). The aim of this study was to establish the extent to which movement strategies transfer between three common assessment tasks to help improve design of athlete testing batteries following ACLR. A cohort of 127 male patients 8-10 months post-ACLR and 45 non-injured controls took part in the study. Three movement tasks were completed (unilateral and bilateral drop jump, and 90° pre-planned cut), while ground reaction forces and three-dimensional kinematics (250 Hz) were recorded. Compared to the bilateral drop jump and cut, the unilateral drop jump had a higher proportion of work done at the ankle (d = 0.29, p < 0.001 and d = -1.87, p < 0.001, respectively), and a lower proportion of work done at the knee during the braking phase of the task (d = 0.447, p < 0.001 and d = 1.56, p < 0.001, respectively). The ACLR group had higher peak hip moments than the non-injured controls, although the proportion of work done at the ankle, knee and hip joints were similar. Movement strategies were moderately and positively related at the ankle (rs  = 0.728, p < 0.001), knee (rs  = 0.638, p < 0.001) and hip (rs  = 0.593, p < 0.001) between the unilateral and bilateral drop jump, but there was no relationship at the ankle (rs  = 0.10, p = 0.104), knee (rs  = 0.106, p = 0.166) and hip (rs  = -0.019, p = 0.808) between the unilateral drop jump and the cut. Clinicians could therefore consider omitting one of the drop jumps from assessment batteries but should include both jumping and cutting tasks.

Recurrent and Subsequent Injuries in Professional and Elite Sport: a Systematic Review.

BACKGROUND: Injury surveillance in professional sport categorises injuries as either "new" or "recurrent". In an attempt to make categorisation more specific, subsequent injury categorisation models have been developed, but it is not known how often these models are used. The aim was to assess how recurrent and subsequent injuries are reported within professional and elite sport. METHODS: Online databases were searched using a search strategy. Studies needed to prospectively report injury rates within professional or elite sports that have published consensus statements for injury surveillance. RESULTS: A total of 1322 titles and abstract were identified and screened. One hundred and ninety-nine studies were screened at full text resulting in 81 eligible studies. Thirty studies did not report recurrent injuries and were excluded from data extraction. Within the studies that reported recurrent injuries, 21 reported the number and percentage; 13 reported only the proportion within all injuries; three reported only the number; five reported the number, percentage and incidence; and two only reported the incidence. Seven studies used subsequent injury terminology, with three reporting subsequent injury following concussion, one using an amended subsequent injury model and three using specific subsequent injury categorisation models. The majority of subsequent injuries (ranging from 51 to 80%) were categorised as different and unrelated to the index injury. The proportion of recurrent injuries (exact same body area and nature related to index injury) ranged from 5 to 21%. CONCLUSIONS: Reporting recurrent or subsequent injuries remains inconsistent, and few studies have utilised subsequent injury models. There is limited understanding of subsequent injury risk, which may affect the development of injury prevention strategies. TRIAL REGISTRATION: CRD42019119264.

Activity Intensity, Volume, and Norms: Utility and Interpretation of Accelerometer Metrics.

PURPOSE: The physical activity profile can be described from accelerometer data using two population-independent metrics: average acceleration (ACC, volume) and intensity gradient (IG, intensity). This article aims 1) to demonstrate how these metrics can be used to investigate the relative contributions of volume and intensity of physical activity for a range of health markers across data sets and 2) to illustrate the future potential of the metrics for generation of age and sex-specific percentile norms. METHODS: Secondary data analyses were conducted on five diverse data sets using wrist-worn accelerometers (ActiGraph/GENEActiv/Axivity): children (n = 145), adolescent girls (n = 1669), office workers (n = 114), premenopausal (n = 1218) and postmenopausal (n = 1316) women, and adults with type 2 diabetes (n = 475). Open-source software (GGIR) was used to generate ACC and IG. Health markers were (a) zBMI (children), (b) %fat (adolescent girls and adults), (c) bone health (pre- and postmenopausal women), and (d) physical function (adults with type 2 diabetes). RESULTS: Multiple regression analyses showed that IG, but not ACC, was independently associated with zBMI/%fat in children and adolescents. In adults, associations were stronger and the effects of ACC and IG were additive. For bone health and physical function, interactions showed associations were strongest if IG was high, largely irrespective of ACC. Exemplar illustrative percentile "norms" showed the expected age-related decline in physical activity, with greater drops in IG across age than ACC. CONCLUSION: The ACC and the IG accelerometer metrics facilitate the investigation of whether volume and intensity of physical activity have independent, additive, or interactive effects on health markers. In future studies, the adoption of data-driven metrics would facilitate the generation of age- and sex-specific norms that would be beneficial to researchers.

A data-driven, meaningful, easy to interpret, standardised accelerometer outcome variable for global surveillance.

OBJECTIVES: Our aim is to demonstrate how a data-driven accelerometer metric, the acceleration above which a person's most active minutes are accumulated, can (a) quantify the prevalence of meeting current physical activity guidelines for global surveillance and (b) moving forward, could inform accelerometer-driven physical activity guidelines. Unlike cut-point methods, the metric is population-independent (e.g. age) and potentially comparable across datasets. DESIGN: Cross-sectional, secondary data analysis. METHODS: Analyses were carried out on five datasets using wrist-worn accelerometers: children (N=145), adolescent girls (N=1669), office workers (N=114), pre- (N=1218) and post- (N=1316) menopausal women, and adults with type 2 diabetes (N=475). Open-source software (GGIR) was used to generate the magnitude of acceleration above which a person's most active 60, 30 and 2min are accumulated: M60ACC; M30ACC and M2ACC, respectively. RESULTS: The proportion of participants with M60ACC (children) and M30ACC (adults) values higher than accelerations representative of brisk walking (i.e., moderate-to-vigorous physical activity) ranged from 17 to 68% in children and 15 to 81% in adults, tending to decline with age. The proportion of pre-and post-menopausal women with M2ACC values meeting thresholds for bone health ranged from 6 to 13%. CONCLUSIONS: These metrics can be used for global surveillance of physical activity, including assessing prevalence of meeting current physical activity guidelines. As accelerometer and corresponding health data accumulate it will be possible to interpret the metrics relative to age- and sex- specific norms and derive evidence-based physical activity guidelines directly from accelerometer data for use in future global surveillance. This is where the potential advantages of these metrics lie.

Prospective study of biomechanical risk factors for second and third metatarsal stress fractures in military recruits.

OBJECTIVES: This prospective study investigated anatomical and biomechanical risk factors for second and third metatarsal stress fractures in military recruits during training. DESIGN: Prospective cohort study. METHODS: Anatomical and biomechanical measures were taken for 1065 Royal Marines recruits at the start of training when injury-free. Data included passive range of ankle dorsi-flexion, dynamic peak ankle dorsi-flexion and plantar pressures during barefoot running. Separate univariate regression models were developed to identify differences between recruits who developed second (n=7) or third (n=14) metatarsal stress fracture and a cohort of recruits completing training with no injury (n=150) (p<0.05). A multinomial logistic regression model was developed to predict the risk of injury for the two sites compared with the no-injury group. Multinomial logistic regression results were back transformed from log scale and presented in Relative Risk Ratios (RRR) with 95% confidence intervals (CI). RESULTS: Lower dynamic arch index (high arch) (RRR: 0.75, CI: 0.63-0.89, p<0.01) and lower foot abduction (RRR: 0.87, CI: 0.80-0.96, p<0.01) were identified as increasing risk for second metatarsal stress fracture, while younger age (RRR: 0.78, CI: 0.61-0.99, p<0.05) and later peak pressure at the second metatarsal head area (RRR: 1.19, CI: 1.04-1.35, p<0.01) were identified as risk factors for third metatarsal stress fracture. CONCLUSIONS: For second metatarsal stress fracture, aspects of foot type have been identified as influencing injury risk. For third metatarsal stress fracture, a delayed forefoot loading increases injury risk. Identification of these different injury mechanisms can inform development of interventions for treatment and prevention.

Wrist-worn Accelerometry for Runners: Objective Quantification of Training Load.

PURPOSE: This study aimed to apply open-source analysis code to raw habitual physical activity data from wrist-worn monitors to: 1) objectively, unobtrusively, and accurately discriminate between "running" and "nonrunning" days; and 2) develop and compare simple accelerometer-derived metrics of external training load with existing self-report measures. METHODS: Seven-day wrist-worn accelerometer (GENEActiv; Activinsights Ltd, Kimbolton, UK) data obtained from 35 experienced runners (age, 41.9 ± 11.4 yr; height, 1.72 ± 0.08 m; mass, 68.5 ± 9.7 kg; body mass index, 23.2 ± 2.2 kg·m; 19 [54%] women) every other week over 9 to 18 wk were date-matched with self-reported training log data. Receiver operating characteristic analyses were applied to accelerometer metrics ("Average Acceleration," "Most Active-30mins," "Mins≥400 mg") to discriminate between "running" and "nonrunning" days and cross-validated (leave one out cross-validation). Variance explained in training log criterion metrics (miles, duration, training load) by accelerometer metrics (Mins≥400 mg, "workload (WL) 400-4000 mg") was examined using linear regression with leave one out cross-validation. RESULTS: Most Active-30mins and Mins≥400 mg had >94% accuracy for correctly classifying "running" and "nonrunning" days, with validation indicating robustness. Variance explained in miles, duration, and training load by Mins≥400 mg (67%-76%) and WL400-4000 mg (55%-69%) was high, with validation indicating robustness. CONCLUSIONS: Wrist-worn accelerometer metrics can be used to objectively, unobtrusively, and accurately identify running training days in runners, reducing the need for training logs or user input in future prospective research or commercial activity tracking. The high percentage of variance explained in existing self-reported measures of training load by simple, accelerometer-derived metrics of external training load supports the future use of accelerometry for prospective, preventative, and prescriptive monitoring purposes in runners.

A small amount of precisely measured high-intensity habitual physical activity predicts bone health in pre- and post-menopausal women in UK Biobank.

Background: Physical inactivity is a highly modifiable risk factor for the development of osteoporosis but, due to a lack of research that has precisely and objectively meaured physical activity (PA) relevant to bone, the specific contribution that PA can make to bone health is poorly understood. This study examined whether a more precise measure of PA relelvant to bone was associated with meaures of bone health in pre- and post-menopausal women in UK Biobank. Methods: Time spent at intensities specific to bone health [≥750 milli-gravitational units (mg) and ≥1000 mg] were analysed from raw tri-axial acceleration data averaged over 1-second epochs from 7-day monitoring of habitual PA using accelerometry-based activity monitors (100 Hz; AX3, Axivity, UK) of 1218 pre- and 1316 post-menopausal healthy women. In a cross-sectional analysis, associations between categories of time (<1, 1-2 and ≥2 minutes) spent above the intensity thresholds and calcaneal quantitative ultrasound measures of bone health (bone mineral density T-score, BMDT-score; speed of sound, SOS; and broadband ultrasound attenuation, BUA) were examined. Results: Compared with <1 minute, spending 1-2 or ≥2 minutes/day at intensities ≥1000 mg in pre-menopausal and ≥750 mg in post-menopausal women was positively associated with BMDT-score, SOS and BUA. Conclusion: Brief bursts of high-intensity PA relevant to bone health can be captured by applying bone-specific thresholds of intensity to raw tri-axial accelerations averaged over 1-second epochs. Accumulating 1-2 minutes/day of high-intensity PA, equivalent to running in pre-menopausal women and slow jogging in post-menopausal women, is associated with better bone health.

Biomechanical responses to changes in friction on a clay court surface.

OBJECTIVES: To examine the influence of clay court frictional properties on tennis players' biomechanical response. DESIGN: Repeated measures. METHODS: Lower limb kinematic and force data were collected on sixteen university tennis players during 10×180° turns (running approach speed 3.9±0.20ms-1) on a synthetic clay surface of varying friction levels. To adjust friction levels the volume of sand infill above the force plate was altered (kg per m2 surface area; 12, 16 and 20kgm-2). Repeated measures ANOVA and Bonferroni's corrected alpha post-hoc analyses were conducted to identify significant differences in lower limb biomechanics between friction levels. RESULTS: Greater sliding distances (ηp2=0.355, p=0.008) were observed for the lowest friction condition (20kgm-2) compared to the 12 and 16kgm-2 conditions. No differences in ankle joint kinematics and knee flexion angles were observed. Later peak knee flexion occurred on the 20kgm-2 condition compared to the 12kgm-2 (ηp2=0.270, p=0.023). Lower vertical (ηp2=0.345, p=0.027) and shear (ηp2=0.396, p=0.016) loading rates occurred for the 20kgm2 condition compared to the 16kgm2. CONCLUSIONS: Lower loading rates and greater sliding distances when clay surface friction was reduced suggests load was more evenly distributed over time reducing players' injury risks. The greater sliding distances reported were accompanied with later occurrence of peak knee flexion, suggesting longer time spent braking and a greater requirement for muscular control increasing the likelihood of fatigue.

Four biomechanical and anthropometric measures predict tibial stress fracture: a prospective study of 1065 Royal Marines.

BACKGROUND: Tibial stress fractures (TSFs) cause a significant burden to Royal Marines recruits. No prospective running gait analyses have previously been performed in military settings. AIM: We aimed to identify biomechanical gait factors and anthropometric variables associated with increased risk of TSF. METHODS: 1065 Royal Marines recruits were assessed in week 2 of training. Bilateral plantar pressure and three-dimensional lower limb kinematics were obtained for barefoot running at 3.6 m/s, providing dynamic arch index, peak heel pressure and lower limb joint angles. Age, bimalleolar breadth, calf girth, passive hip internal/external range of motion and body mass index (BMI) were also recorded. 10 recruits who sustained a TSF during training were compared with 120 recruits who completed training injury-free using a binary logistic regression model to identify injury risk factors. RESULTS: 4 variables significantly (p<0.05) predicted increased risk of TSF (ORs and 95% CI): smaller bimalleolar width (0.73, 0.58 to 0.93), lower BMI (0.56, 0.33 to 0.95), greater peak heel pressure (1.25, 1.07 to 1.46) and lower range of tibial rotation (0.78, 0.63 to 0.96). SUMMARY: Reduced impact attenuation and ability to withstand load were implicated in tibial stress fracture risk.

The influence of tennis court surfaces on player perceptions and biomechanical response.

This study aimed to examine player perceptions and biomechanical responses to tennis surfaces and to evaluate the influence of prior clay court experience. Two groups with different clay experiences (experience group, n = 5 and low-experience group, n = 5) performed a 180° turning movement. Three-dimensional ankle and knee movements (50 Hz), plantar pressure of the turning step (100 Hz) and perception data (visual analogue scale questionnaire) were collected for two tennis courts (acrylic and clay). Greater initial knee flexion (acrylic 20. 8 ± 11.2° and clay 32.5 ± 9.4°) and a more upright position were reported on the clay compared to the acrylic court (P < 0.05). This suggests adaptations to increase player stability on clay. Greater hallux pressures and lower midfoot pressures were observed on the clay court, allowing for sliding whilst providing grip at the forefoot. Players with prior clay court experience exhibited later peak knee flexion compared to those with low experience. All participants perceived the differences in surface properties between courts and thus responded appropriately to these differences. The level of previous clay court experience did not influence players' perceptions of the surfaces; however, those with greater clay court experience may reduce injury risk as a result of reduced loading through later peak knee flexion.

Comparability of measured acceleration from accelerometry-based activity monitors.

BACKGROUND: Accelerometers that provide triaxial measured acceleration data are now available. However, equivalence of output between brands cannot be assumed and testing is necessary to determine whether features of the acceleration signal are interchangeable. PURPOSE: This study aimed to establish the equivalence of output between two brands of monitor in a laboratory and in a free-living environment. METHODS: For part 1, 38 adults performed nine laboratory-based activities while wearing an ActiGraph GT3X+ and GENEActiv (Gravity Estimator of Normal Everyday Activity) at the hip. For part 2, 58 children age 10-12 yr wore a GT3X+ and GENEActiv at the hip for 7 d in a free-living setting. RESULTS: For part 1, the magnitude of time domain features from the GENEActiv was greater than that from the GT3X+. However, frequency domain features compared well, with perfect agreement of the dominant frequency for 97%-100% of participants for most activities. For part 2, mean daily acceleration measured by the two brands was correlated (r = 0.93, P < 0.001, respectively) but the magnitude was approximately 15% lower for the GT3X+ than that for the GENEActiv at the hip. CONCLUSIONS: Frequency domain-based classification algorithms should be transferable between monitors, and it should be possible to apply time domain-based classification algorithms developed for one device to the other by applying an affine conversion on the measured acceleration values. The strong relation between accelerations measured by the two brands suggests that habitual activity level and activity patterns assessed by the GENE and GT3X+ may compare well if analyzed appropriately.

Cadence, peak vertical acceleration, and peak loading rate during ambulatory activities: implications for activity prescription for bone health.

BACKGROUND: Previous research has reported peak vertical acceleration and peak loading rate thresholds beneficial to bone mineral density (BMD). Such thresholds are difficult to translate into meaningful recommendations for physical activity. Cadence (steps/min) is a more readily interpretable measure of ambulatory activity. OBJECTIVE: To examine relationships between cadence, peak vertical acceleration and peak loading rate during ambulation and identify the cadence associated with previously reported bone-beneficial thresholds for peak vertical acceleration (4.9 g) and peak loading rate (43 BW/s). METHODS: Ten participants completed 8 trials each of: slow walking, brisk walking, slow running, and fast running. Acceleration data were captured using a GT3×+ accelerometer worn at the hip. Peak loading rate was collected via a force plate. RESULTS: Strong relationships were identified between cadence and peak vertical acceleration (r = .96, P < .05) and peak loading rate (r = .98, P < .05). Regression analyses indicated cadences of 157 ± 12 steps/min (2.6 ± 0.2 steps/s) and 122 ± 10 steps/min (2.0 ± 0.2 steps/s) corresponded with the 4.9 g peak vertical acceleration and 43 BW/s peak loading rate thresholds, respectively. CONCLUSIONS: Cadences ≥ 2.0 to 2.6 steps/s equate to acceleration and loading rate thresholds related to bone health. Further research is needed to investigate whether the frequency of daily occurrences of this cadence is associated with BMD.

Use of accelerometry to classify activity beneficial to bone in premenopausal women.

PURPOSE: The aims of this study were to quantify the relation between ground reaction force (GRF) and peak acceleration from hip- and wrist-worn accelerometers and determine peak acceleration cut-points associated with a loading rate previously demonstrated as beneficial to bone (43 body weights (BW)·s⁻¹) in premenopausal women. METHODS: Forty-seven premenopausal women (age, 39.2 ± 5.6 yr; mass, 65.9 ± 11.0 kg; height, 1.67 ± 0.06 m) performed walking (slow, fast, and with bag), floor sweeping, running (slow and fast), jumping (low, <5 cm; high, >5 cm), and box drop (20 cm) trials. Peak accelerations were sampled at 100 Hz by GENEActiv and ActiGraph GT3X+ accelerometers (ActiGraph LLC, Pensacola, FL) worn at the hip (vertical and resultant) and the wrist (resultant). A force plate (960 Hz, AMTI) was used to assess peak vertical GRF and peak loading rate for eight steps per activity. Receiver operating characteristic curves were used to determine the optimal peak acceleration cut-points associated with a loading rate of 43 BW·s⁻¹ in 37 participants, and these cut-points were cross-validated in the remaining 10 participants. RESULTS: For all activities combined, peak accelerations were positively and significantly (P < 0.001) correlated with peak vertical GRF (hip r > 0.8, wrist r > 0.7) and peak loading rate (hip r > 0.7, wrist r > 0.57). Irrespective of monitor type and wear site, peak acceleration discriminated between loading rates above and below 43 BW·s⁻¹ with high levels of accuracy (area under the curve >0.92, P < 0.001). Overall classification agreement was >85% for both monitors worn at either the wrist or hip in the cross-validation sample. CONCLUSION: GENEActiv and ActiGraph GT3X+ accelerometers worn at the wrist or hip can be used as an unobtrusive tool to identify the occurrence of loading rates likely beneficial to bone in premenopausal women during their daily activity.

Biomechanical response to changes in natural turf during running and turning.

Integrated biomechanical and engineering assessments were used to determine how humans responded to variations in turf during running and turning. Ground reaction force (AMTI, 960 Hz) and kinematic data (Vicon Peak Motus, 120 Hz) were collected from eight participants during running (3.83 m/s) and turning (10 trials per condition) on three natural turf surfaces in the laboratory. Surface hardness (Clegg hammer) and shear strength (cruciform shear vane) were measured before and after participant testing. Peak loading rate during running was significantly higher (p < .05) on the least hard surface (sandy; 101.48 BW/s ± 23.3) compared with clay (84.67 BW/s ± 22.9). There were no significant differences in running kinematics. Compared with the "medium" condition, fifth MTP impact velocities during turning were significantly (RM-ANOVA, p < .05) lower on clay (resultant: 2.30 m/s [± 0.68] compared with 2.64 m/s [± 0.70]), which was significantly (p < .05) harder "after" and had the greatest shear strength both "before" and "after" participant testing. This unique finding suggests that further study of foot impact velocities are important to increase understanding of overuse injury mechanisms.

Natural turf surfaces: the case for continued research.

It is well documented that health and social benefits can be attained through participation in sport and exercise. Participation, particularly in sports, benefits from appropriate surface provisions that are safe, affordable and high quality preferably across the recreational to elite continuum. Investment, construction and research into artificial sports surfaces have increased to meet this provision. However, not all sports (e.g. golf, rugby and cricket) are suited to training and match-play on artificial turf without compromising some playing characteristics of the games. Therefore, full sport surface provision cannot be met without the use of natural turf surfaces, which also have an important role as green spaces in the built environment. Furthermore, a significant number of people participate in outdoor sport on natural turf pitches, although this is a declining trend as the number of synthetic turf surfaces increases. Despite natural turf being a common playing surface for popular sports such as soccer, rugby and cricket, few biomechanical studies have been performed using natural turf conditions. It is proposed that if natural turf surfaces are to help meet the provision of sports surfaces, advancement in the construction and sustainability of natural turf surface design is required. The design of a natural turf surface should also be informed by knowledge of surface-related overuse injury risk factors. This article reviews biomechanical, engineering, soil mechanics, turfgrass science, sports medicine and injury-related literature with a view to proposing a multidisciplinary approach to engineering a more sustainable natural turf sport surface. The present article concludes that an integrated approach incorporating an engineering and biomechanical analysis of the effects of variations in natural turf media on human movement and the effects of variations in human movement on natural turf is primarily required to address the longer-term development of sustainable natural turf playing surfaces. It also recommends that the use of 'natural turf' as a catch-all categorization in injury studies masks the spatial and temporal variation within and among such surfaces, which could be important.