Females and males use different hip and knee mechanics in response to symmetric military-relevant loads.

The purpose of this study was to determine if females and males use different hip and knee mechanics when walking with standardized military-relevant symmetric loads. Fifteen females and fifteen males walked on a treadmill for 2-min at a constant speed under three symmetric load conditions (unloaded: 1.71 kg, medium: 15 kg, heavy: 26 kg). Kinematic and kinetics of the hip and knee were calculated in the sagittal and frontal planes of the dominant limb. In females, hip abduction moments (normalized to total mass) and sagittal knee excursion decreased with increased load (p ≤ 0.024). In males, hip frontal excursion and adduction angle increased with load (p ≤ 0.003). Females had greater peak hip adduction angle than males in the unloaded and medium load conditions (p ≤ 0.036). Across sex, sagittal hip and knee excursion, peak knee extension angle, and peak hip and knee flexion angles increased with increased load (p ≤ 0.005). When normalized to body mass, all peak joint moments increased with each load (p ≤ 0.016) except peak hip adduction moment. When normalized to total mass, peak hip adduction moment and knee flexion, extension, and adduction moments decreased with each load (p < 0.001). While hip frontal plane kinetic alterations to load were only noted in females, kinematic changes were noted in males at the hip and females at the knee. Differences in strategies may increase the risk of hip and knee injuries in females compared to males. This study noted load and sex effects that were previously undetected, highlighting the importance of using military-relevant standardized loads and investigating frontal plane adaptations.

Load Carriage and Physical Exertion Influence Cognitive Control in Military Scenarios.

INTRODUCTION: Physical exertion has both beneficial and detrimental effects on cognitive performance, particularly cognitive control. Research into physical exertion under conditions of load carriage is particularly important given that military personnel and first responders must perform optimally under such combinatorial physical stressors. The present work sought to characterize cognitive control as a function of physical exertion and load carriage in a military operational scenario. METHODS: Thirty-one active-duty soldiers underwent a 4-h operationally relevant and fatiguing scenario that included two 1-h foot marches under load carriage conditions of 8.8, 47.2, 50.7 kg on each of three separate days. During each foot march, they completed five 5-min blocks of an auditory go/no-go task of response inhibition. RESULTS: Results showed that response inhibition declined with increasing load carriage and physical exertion, as evidenced by lower proportion of correct responses, higher proportion of false alarms, and lower response sensitivity between all three load conditions, particularly upon successive foot marches and time blocks within each foot march. CONCLUSIONS: The results support previous laboratory-based work on load carriage and physical exertion and suggest that deteriorations in cognitive control witnessed in laboratory settings are more pronounced within realistic operational scenarios akin to those encountered by military personnel and first responders.

Spatiotemporal Parameters are not Substantially Influenced by Load Carriage or Inclination During Treadmill and Overground Walking.

Influences of load carriage and inclination on spatiotemporal parameters were examined during treadmill and overground walking. Ten soldiers walked on a treadmill and overground with three load conditions (00 kg, 20 kg, 40 kg) during level, uphill (6% grade) and downhill (-6% grade) inclinations at self-selected speed, which was constant across conditions. Mean values and standard deviations for double support percentage, stride length and a step rate were compared across conditions. Double support percentage increased with load and inclination change from uphill to level walking, with a 0.4% stance greater increase at the 20 kg condition compared to 00 kg. As inclination changed from uphill to downhill, the step rate increased more overground (4.3 ± 3.5 steps/min) than during treadmill walking (1.7 ± 2.3 steps/min). For the 40 kg condition, the standard deviations were larger than the 00 kg condition for both the step rate and double support percentage. There was no change between modes for step rate standard deviation. For overground compared to treadmill walking, standard deviation for stride length and double support percentage increased and decreased, respectively. Changes in the load of up to 40 kg, inclination of 6% grade away from the level (i.e., uphill or downhill) and mode (treadmill and overground) produced small, yet statistically significant changes in spatiotemporal parameters. Variability, as assessed by standard deviation, was not systematically lower during treadmill walking compared to overground walking. Due to the small magnitude of changes, treadmill walking appears to replicate the spatiotemporal parameters of overground walking.

The Effects of Load Carriage and Physical Fatigue on Cognitive Performance.

In the current study, ten participants walked for two hours while carrying no load or a 40 kg load. During the second hour, treadmill grade was manipulated between a constant downhill or changing between flat, uphill, and downhill grades. Throughout the prolonged walk, participants performed two cognitive tasks, an auditory go no/go task and a visual target detection task. The main findings were that the number of false alarms increased over time in the loaded condition relative to the unloaded condition on the go no/go auditory task. There were also shifts in response criterion towards responding yes and decreased sensitivity in responding in the loaded condition compared to the unloaded condition. In the visual target detection there were no reliable effects of load carriage in the overall analysis however, there were slower reaction times in the loaded compared to unloaded condition during the second hour.

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.

Marksmanship deficits caused by an exhaustive whole-body lifting task with and without torso-borne loads.

Studies of exhaustive exercise on marksmanship are inconclusive and have not measured trigger pull latencies (LAT) nor considered impact of added torso loads. This study examined the impact of exhaustive whole-body exercise and torso loading on accuracy, precision, and latency during a marksmanship test. Twelve men lifted a 20.5-kg box on to a 1.55-m high shelf until they could not maintain a 12 lifts·min⁻¹ pace. Within 25 seconds of ending the lifting task, the subjects started a 10-minute rifle marksmanship test (8 shots·min⁻¹). During lifting and shooting, the subjects wore 2 different loads: NOLOAD = boots, uniform, and helmet (5.9 kg) and LOAD = a torso-borne load (29.9 kg) + NOLOAD. With the LOAD, the subjects were only able to work for 69% as long, perform 31% as many lifts, or do 38% as much total work compared with the NOLOAD condition. Despite performing less total external work during LOAD, the heart rate (HR) was more than 25% higher than NOLOAD. Measures of accuracy and precision improved and stabilized after minute 3. Overall, LAT increased (p < 0.025) for LOAD (mean ± SE, 2,522 ± 81 milliseconds), compared with NOLOAD (2,240 ± 121). During 0-4 minutes, LAT for LOAD was 14% greater than for NOLOAD (p < 0.05); from 4 to 10 minutes, LAT did not differ. Exhaustive whole-body exercise transiently degraded accuracy regardless of load. In the LOAD condition, LAT was immediately increased and sustained for 10 minutes; in the NOLOAD condition, LAT increased gradually. Although load did not decrease accuracy, it increased the time to engage targets, which can impact fighting effectiveness and survivability.

Carrying a rifle with both hands affects upper body transverse plane kinematics and pelvis-trunk coordination.

The purpose of this study was to assess how carrying a rifle in both hands affects upper body motion and coordination during locomotion. In total, 11 male soldiers walked (1.34 m/s) and ran (2.46 m/s) with a weapon (M4 condition) and without a weapon (NW condition) while kinematic pelvis and trunk data were collected. Two-way ANOVA was used to compare segmental ranges of motion (ROM), pelvis-trunk coordination (continuous relative phase) and coordination variability between gait mode and weapon combinations. Carrying a weapon decreased sagittal plane trunk ROM at both speeds and increased trunk rotation during running. Mean (±SD) transverse plane coordination was more in-phase while carrying a weapon (M4 = 83°±31, NW = 60°±36, p = 0.027) and transverse plane coordination variability decreased (M4 = 23°±3.6, NW = 15°±4.4, p = 0.043). Coordination differences between M4 and NW were similar to differences reported in the literature between individuals with and without back pain. Long-term injury implications due to decreased coordination variability are discussed. STATEMENT OF RELEVANCE: Knowledge of the effects of rifle carriage on pelvis-trunk coordination may provide insight into short-term protective strategies and long-term injury mechanisms. These should be considered in occupations requiring individuals to carry torso loads in combination with holding an object in both hands that restricts arm swing.

Effects of a lower-body exoskeleton device on metabolic cost and gait biomechanics during load carriage.

This study investigated the effects on metabolic cost and gait biomechanics of using a prototype lower-body exoskeleton (EXO) to carry loads. Nine US Army participants walked at 1.34 m/s on a 0% grade for 8 min carrying military loads of 20 kg, 40 kg and 55 kg with and without the EXO. Mean oxygen consumption (VO(2)) scaled to body mass and scaled to total mass were significantly higher, by 60% and 41% respectively, when the EXO was worn, compared with the control condition. Mean VO(2) and mean VO(2) scaled to body mass significantly increased with load. The kinematic and kinetic data revealed significant differences between EXO and control conditions, such as walking with a more flexed posture and braking with higher ground reaction force at heel strike when wearing the EXO. Study findings demonstrate that the EXO increased users' metabolic cost while carrying various loads and altered their gait biomechanics compared with conventional load carriage. STATEMENT OF RELEVANCE: An EXO designed to assist in load bearing was found to raise energy expenditure substantially when tested by soldiers carrying military loads. EXO weight, weight distribution and design elements that altered users' walking biomechanics contributed to the high energy cost. To realise the potential of EXOs, focus on the user must accompany engineering advances.

Nonlinear analysis of gait kinematics to track changes in oxygen consumption in prolonged load carriage walking: a pilot study.

Linking human mechanical work to physiological work for the purpose of developing a model of physical fatigue is a complex problem that cannot be solved easily by conventional biomechanical analysis. The purpose of the study was to determine if two nonlinear analysis methods can address the fundamental issue of utilizing kinematic data to track oxygen consumption from a prolonged walking trial: we evaluated the effectiveness of dynamical systems and fractal analysis in this study. Further, we selected, oxygen consumption as a measure to represent the underlying physiological measure of fatigue. Three male US Army Soldier volunteers (means: 23.3 yr; 1.80 m; 77.3 kg) walked for 120 min at 1.34 m/s with a 40-kg load on a level treadmill. Gait kinematic data and oxygen consumption (VO(2)) data were collected over the 120-min period. For the fractal analysis, utilizing stride interval data, we calculated fractal dimension. For the dynamical systems analysis, kinematic angle time series were used to estimate phase space warping based features at uniform time intervals: smooth orthogonal decomposition (SOD) was used to extract slowly time-varying trends from these features. Estimated fractal dimensions showed no apparent trend or correlation with independently measured VO(2). While inter-individual difference did exist in the VO(2) data, dominant SOD time trends tracked and correlated with the VO(2) for all volunteers. Thus, dynamical systems analysis using gait kinematics may be suitable to develop a model to predict physiologic fatigue based on biomechanical work.

The effects of a lower body exoskeleton load carriage assistive device on limits of stability and postural sway.

The study investigated the effects of using a lower body prototype exoskeleton (EXO) on static limits of stability and postural sway. Measurements were taken with participants, 10 US Army enlisted men, standing on a force platform. The men were tested with and without the EXO (15 kg) while carrying military loads of 20, 40 and 55 kg. Body lean to the left and right was significantly less and postural sway excursions and maximal range of movement were significantly reduced when the EXO was used. Hurst values indicated that body sway was less random over short-term time intervals and more random over long-term intervals with the EXO than without it. Feedback to the user's balance control mechanisms most likely was changed with the EXO. The reduced sway and relatively small changes in sway with increasing load weights suggest that the EXO structure may have functioned to provide a bracing effect on the body.

The effects of movement and physical exertion on soldier vigilance.

INTRODUCTION: The effects of movement and physical exertion on cognitive processes remain unclear. Some studies report improvements in information processing while others report decrements or no change. To address relationships between movement, physical exertion, and cognitive performance, vigilance performance while soldiers walked with a heavy (40 kg) load was examined. METHODS: Volunteers (n = 18) completed six 30-min test sessions on separate days: standing; walking with or without obstacles; while carrying a 40-kg load or no load. Suprathreshold visual, auditory or tactile stimuli were presented during the vigilance task. Dependent measures included accuracy, response time and distance traversed. RESULTS: Volunteers reported higher perceived exertion (p < 0.05) when carrying a load and these ratings increased with time (p < 0.05). There were fewer correct responses on the vigilance task when carrying a load (p < 0.05) or when walking over obstacles (p < 0.05). Vigilance performance was superior with auditory compared with visual or tactile stimuli (p < 0.05). Less distance was covered when carrying a load (p < 0.05), traversing the course with obstacles (p < 0.05), and when responding to a tactile, compared with an auditory, stimulus (p < 0.05). DISCUSSION: These results indicate walking around obstacles and the exertion of load carriage affect performance on the basic cognitive function of vigilance. Furthermore, they raise fundamental questions about whether cognitive performance data collected from sedentary, rested volunteers are applicable to individuals, including dismounted soldiers, engaged in tasks that concurrently require physical and cognitive resources.

Discrete bandwidth visual feedback increases structure of output as compared to continuous visual feedback in isometric force control tasks.

BACKGROUND: Performance variability measures provide a partial picture of force control ability. Nonlinear analyses can reveal important information related to the randomness and complexity of the data, providing a more complete picture of the physiological process. METHODS: We investigated the effects of visual feedback on the structure and performance of the force output from isometric force control tasks. Twelve young volunteers completed isometric force control tasks using two types of visual feedback: discrete bandwidth (+/-4% maximal voluntary contraction) and continuous line matching. We determined force signal variability (standard deviation), self-similarity (fractal dimension), and complexity (approximate entropy). Analyses of variance (feedback x muscle group x force level) were conducted and P values less than 0.05 were considered significant. FINDINGS: The force signal in discrete bandwidth feedback, compared to continuous line matching, had significantly a higher standard deviation (P=.000): 2.18 Nm (SD 1.98) vs. 0.99 Nm (SD 0.91); lower fractal dimension (P=.000): 1.07 (SD 0.04) vs. 1.16 (SD 0.04); and lower approximate entropy (P=.000): 0.12 (SD 0.07) vs. 0.26 (SD 0.09). INTERPRETATION: The greater self-similarity (lower fractal dimension) and greater regularity (lower approximate entropy) of the discrete bandwidth, compared to the continuous line matching, may indicate a process that required more kinesthetic (intrinsic) feedback to modulate force. Clinicians may choose to employ visual feedback paradigms that target the use of intrinsic feedback during rehabilitation. Discrete bandwidth feedback may be useful for delineating impairments in motor skill and measuring outcomes of intervention programs.

Effects of carried weight on random motion and traditional measures of postural sway.

The purpose of the study was to investigate the effects of load weight carried by soldiers upon postural sway. Fourteen US Army enlisted men participated. Postural sway and muscle activity were measured while participants stood on a force plate. The load weight conditions, comprised of Army clothing and load-carriage equipment were 6, 16, and 40 kg. With an increase in load weight, stabilogram-diffusion analysis revealed that random movement of postural sway decreased. Also, with an increase in load weight, center of pressure excursions increased linearly but muscle activity changed minimally. In short, increasing load weight challenged the load carriers' stability, reduced the randomness of postural sway and required the load carriers to exert greater control of the load in order to maintain balance.