Interventions to promote work ability by increasing physical activity among workers with physically strenuous jobs: A scoping review.

Aims: The potential benefits of workplace physical activity (PA) interventions are in improving both health and important workplace outcomes. Despite the differences in PA level between physically strenuous and inactive work, the literature reporting the effectiveness of the interventions does not usually differentiate physically active and inactive jobs. The aim of the current study was therefore to collect and synthesise research evidence on workplace PA interventions to promote work ability specifically among workers in physically strenuous jobs by means of a scoping review. Methods: The databases Medline, Cochrane Central and Scopus were used to identify interventions to promote work ability by increasing PA among workers in physically strenuous jobs. An iterative method was used to obtain an overview of the study elements and to extract details on the study design, sample, intervention, outcomes and effectiveness. Results: A total of 47 studies evaluating eight categories of interventions were found. Out of these, 18 reported significant effects on work ability. Positive results came from a range of different interventions, including aerobic exercise, strength training, combined aerobic exercise and strength training, stretching, yoga, consultation and tailored physical exercise programmes. Conclusions: Few interventions were effective in promoting work ability by increasing PA among workers in physically strenuous jobs. In particular, trials based on the demands of work, multimodal interventions and applying wearable technology are needed.

The effect of mild whole-body cold stress on isometric force control during hand grip and key pinch tasks.

Prolonged exposure to cold can impair manual performance, which in turn can affect work task performance. We investigated whether mild whole-body cold stress would affect isometric force control during submaximal hand grip and key pinch tasks. Twelve male participants performed isometric hand grip and key pinch tasks at 10% and 30% of maximal voluntary contraction (MVC) for 30 and 10 s respectively, in cold (8 °C) and control (25 °C) conditions. Finger temperature decreased significantly by 18.7 ±â€¯2.1 °C and continuous low-intensity shivering in the upper trunk increased significantly in intensity and duration during cold exposure. Rectal temperature decreased similarly for the 8 °C and 25 °C exposures. Force variability (FCv) was <2% for the hand grip tasks, and <3% for the key pinch tasks. No significant changes in FCv or force accuracy were found between the ambient temperatures. In conclusion, isometric force control during hand grip and key pinch tasks was maintained when participants experienced mild whole-body cold stress compared with when they were thermally comfortable.

Social participation and heat-related behavior in older adults during heat waves and on other days.

BACKGROUND: High indoor temperatures require behavioral adaptation, especially among vulnerable older adults. There are uncertainties as to the degree to which people adapt to these challenging conditions. OBJECTIVE: The aim of this study was to describe the degree of adaptation of social participation and other heat-related behavior with respect to higher indoor temperatures. METHODS: In this study 81 residents from 10 sheltered living facilities (84% women, mean age 80.9 years) were visited every 4 weeks from May to October 2015 and additionally during 2 heat waves in July and August 2015. The indoor temperature, drinking and clothing and social participation were documented. Baseline documentation of gait speed and residential area were used to create subgroups of people with high or low gait speed and with facility location in a garden city/suburb or city/city center. RESULTS: Social participation and clothing decreased with -4.53 in the World Health Organization participation score units (95% confidence interval CI -5.32; -3.74) and -0.41 for clothing units (95% CI -0.46; -0.37) and volume of drinking increased (0.65 l/day; 95% CI 0.52; 0.77) per increase of indoor temperature by 10 °C. The negative association between indoor temperature and social life participation was stronger if functional capacity was low or if the facility was located in the city/city center. Not all older adults displayed temperature-related adaptive behavior. CONCLUSION: For older adults the negative association between indoor temperature and social life participation was stronger in the city/city center or if their functional capacity was low. Frequent personal contact and motivation of those who are frail might be helpful to support their adaptive behavior of drinking and clothing during heat stress.

Effect of cold indoor environment on physical performance of older women living in the community.

BACKGROUND: the effects of cold on older persons' body and mind are not well documented, but with an increased number of older people with decreasing physical performance, these possible effects need to be understood. OBJECTIVE: to investigate the effect of cold indoor environment on physical performance of older women. DESIGN: cross-sectional experimental study with two test conditions. SETTING: movement laboratory in a climate chamber. SUBJECTS: eighty-eight community-dwelling, cognitively unimpaired older women (mean age 78 years). METHODS: participants were exposed to moderately cold (15°C) and warm/normal (25°C) temperature in a climate chamber in random order with an interval of 1 week. The assessment protocol included leg extensor power (Nottingham Power Rig), sit-to-stand performance velocity (linear encoder), gait speed, walk-ratio (i.e. step length/cadence on an instrumented walk way), maximal quadriceps and hand grip strength. RESULTS: physical performance was lower in 15°C room temperature compared with 25°C room temperature for leg extensor power (P < 0.0001), sit-to-stand performance velocity (P < 0.0001), gait speed (P < 0.0001), walk-ratio (P = 0.016) and maximal quadriceps strength (P = 0.015), but not for hand grip strength. CONCLUSION: in healthy older women a moderately cold indoor environment decreased important physical performance measures necessary for independent living.

Muscular, cardiorespiratory and thermal strain of mast and pole workers.

This field study evaluated the level of muscular, cardiorespiratory and thermal strain of mast and pole workers. We measured the muscular strain using electromyography (EMG), expressed as a percentage in relation to maximal EMG activity (%MEMG). Oxygen consumption (VO2) was indirectly estimated from HR measured during work and expressed as a percentage of maximum VO2 (%VO2max). Skin and deep body temperatures were measured to quantify thermal strain. The highest average muscular strain was found in the wrist flexor (24 ± 1.5%MEMG) and extensor (21 ± 1.0%MEMG) muscles, exceeding the recommendation of 14%MEMG. Average cardiorespiratory strain was 48 ± 3%VO2max. Nearly half (40%) of the participants exceeded the recommended 50%VO2max level. The core body temperature varied between 36.8°C and 37.6°C and mean skin temperature between 28.6°C and 33.4°C indicating possible occasional superficial cooling. Both muscular and cardiorespiratory strain may pose a risk of local and systemic overloading and thus reduced work efficiency. Thermal strain remained at a tolerable level.

Self-rated physical loads of work tasks among firefighters.

OBJECTIVES: The present study sought to identify firefighters' rated physical demands for the most frequently occurring work tasks and to determine if the ratings differed between full-time and part-time firefighters to help create a basis for the development of physical employment tests for firefighters. METHODS: An extensive questionnaire was completed by 125 and 68 firefighters in 2000 and 2010, respectively. The data were analysed with the Mann-Whitney U test and binominal test and ranked on the basis of the responses in each category. RESULTS: Significant differences were seen between the full- and part-time firefighters. The work tasks rated as the most physically strenuous in terms of aerobic fitness, muscle strength, work posture and body control by most respondents were smoke diving upstairs (carrying a hose), victim rescue in different ways, carrying a stretcher over terrain and pulling a hose. CONCLUSIONS: Physically strenuous work tasks should be included in the end-point performance variables used to select physical performance tests for firefighters. The part-time firefighters with no experience in several of the work tasks suggests that work-related exercises are important if both groups of firefighters are expected to do similar work.

Effects of an exoskeleton on muscle activity in tasks requiring arm elevation: Part I - Experiments in a controlled laboratory setting.

BACKGROUND: Long-term work with elevated arms, or overhead work, is a risk factor for musculoskeletal complaints and disorders. Upper-limb exoskeletons are a promising tool for reducing occupational workload when working with hands above shoulder level. OBJECTIVE: The purpose of this study was to assess the effects of upper-limb exoskeleton on muscular and physical strain and perceived exertion during dynamic work at four different shoulder joint angles. Further, we evaluated if there are any negative effects associated with the use of exoskeleton. METHODS: A total of 15 student participants performed dynamic work in laboratory setting with and without an exoskeleton at four different shoulder angles: 60, 90, 120 and 150 degrees. Muscle electrical activity from 8 muscles of the upper body, perceived exertion, and heart rate were measured during the work task, and grip strength, muscle stiffness, tone, and elasticity from six muscles, m. deltoideus physiological cross-sectional area and muscle fiber pennation angle, and nerve conduction velocity were measured before and after the work task. RESULTS: Based on the results, the use of exoskeleton significantly reduced the muscle activity of the upper limb, shoulder, and back muscles. The reduction was most significant when the arm elevation was 120°, and in m. deltoideus muscle activity. RPE was also positively affected indicating reduction in workload when using exoskeleton. CONCLUSION: The results suggest that the use of upper limb exoskeleton has potential to reduce physical workload during overhead work and, consequently, reduce the risk for work-related musculoskeletal disorders.

Effects of upper-limb exoskeleton on muscle activity in tasks requiring arm elevation: Part II - In-field experiments in construction industry settings.

Background: The body of literature regarding the use of an upper limb exoskeleton during authentic working conditions is sparse. Objective: The aim of this study was to evaluate the effectiveness of an upper limb exoskeleton in reducing muscle strain during authentic industrial construction work. Methods: Fifteen male participants, comprising of roofers, scaffolders, builders, bricklayers, and graders performing overhead work participated in the study. During work without (REF) and with exoskeleton (EXO), muscle activity from 8 muscles, heart rate (HR), metabolic equivalent (MET), and upper arm elevation angles were recorded. Results: When using the exoskeleton, a significant reduction of 20.2% in average muscle activity of 8 muscles was found. The largest effect focused on m. deltoideus, where 46.2 and 32.2% reduction occurred in medial and anterior parts of the muscle, respectively. HR and MET were unaffected. Upper arm elevation angles were similar between REF and EXO, indicating equal biomechanical loading. Conclusions: This study indicates that exoskeletons show great promise in reducing the potential for musculoskeletal strain during authentic overhead construction work.

Effect of cold conditions on double poling sprint performance of well-trained male cross-country skiers.

This study compared the effects of cold (-14° C) and moderate environments (6° C) on double poling (DP) sprint performance. Wearing modern cross-country ski racing suits, 14 highly trained male cross-country skiers performed a test protocol on a DP ergometer, consisting of a standardized warm-up followed by a 30-second maximal sprint (DP30s) and a 2-minute maximal sprint (DP2min), and after an 8-minute recovery period, another DP30s and DP2min were performed. Finally, the participants performed an incremental DP test to exhaustion. We observed no difference between rectal temperature in cold and moderate conditions. Mean skin temperature (Tskin) was lower in the cold condition; the lowest values being 20.3° C at -14° C and 27.0° C at 6° C. Power output decreased between the first and the second DP30s under both conditions, but the reduction was 4.9% (p < 0.05) greater in the cold condition. Power output decreased by 4.8% (p < 0.05) between the first and second DP2min at -14° C, but we found no difference at 6° C. In the incremental test to exhaustion, there was a 7.2% (p < 0.05) reduction in peak power output and a 7.8% (p < 0.05) lower peak oxygen consumption at -14° C. In conclusion, this study demonstrated that DP sprint performance was lower at -14° C than at 6° C. Tskin and body temperature were lower at -14° C. This may indicate cooling of superficial musculature and may explain the reduced DP sprint performance observed in our study.

Thermoregulation and shivering responses in elite alpine skiers.

This study aimed to characterise the thermoregulatory responses of elite alpine skiers. Core (gastro-intestinal) and skin temperatures were recorded continuously from 4 national team skiers representing 18 training-sessions for a total of 83 ski runs (average ambient temperature 1.9°C). Shivering responses were estimated from quadriceps and hamstrings EMG recordings during 77 chairlifts. Temperature responses were also obtained from 6 accompanying staffs representing 16 training-sessions (passive in 10 cases, following the skiers in 6 cases). Core temperature of the skiers (P < .001) but not the staff (P = .103) increased during training and was higher in skiers than staff after one-third of the training session (P < .006). Conversely, average skin temperature of the skiers decreased during training (P < .001) and was lower in skiers than staff for the second half of the training. Muscle activity during chairlifts remained below 1% and there was no meaningful shivering. Muscle activity decreased whilst mean and median power frequency increased during the chairlift (P < .020). Muscle activity was also lower during the last lift than the first one whilst mean and median power frequency were higher (P < .020). In conclusion, skin temperature decreased during Slalom and Giant Slalom in elite alpine skiers, likely due to the limited insulative capacity of the racing suit and the high velocity increasing convective heat loss. Conversely, core temperature increased during the training session suggesting that the metabolic heat production was larger than the convective heat loss, and was also sufficient to maintain homeostasis without shivering.

Head Movements and Neck Muscle Activity During Air Combat Maneuvering.

BACKGROUND: The aim of the study was to determine the characteristics of cervical muscle activity in different head movements when using helmet mounted display in air combat maneuvering.METHODS: Cervical EMG was measured with eight F/A-18 pilots using the Joint Helmet Mounted Cueing System (JHMCS) during air combat maneuvering. In-flight Gz acceleration and continuous head position were recorded. Muscular activity was compared between head movements in isolation and combined with torso movement. In addition, the effect of the direction of head movements and the use of head support of the ejection seat on muscle activity was determined.RESULTS: Muscular loading increased in the cervical flexors and extensors when using the torso during targeting beyond the field of vision in the neutral sitting posture; the difference was significant in the flexors, but activity levels were higher in the extensors. Cervical muscles are loaded to a lesser extent if the head is kept in a stable position during Gz loading. Muscular activity in the neck muscles was higher when the pilot was moving the head out of neutral posture rather than toward neutral posture. The use of the headrest as a support decreased muscle activity in the extensors, but resulted in higher activity in the flexor muscles.DISCUSSION: All analyzed conditions were significantly affected by an increase in Gz. An increase of muscle activity with torso movements is considered as a positive factor as it reflects maintained muscular support for the cervical spine. Presented results may be helpful when specific conditioning programs and cockpit ergonomics are developed for fighter pilots.Sovelius R, Mäntylä M, Huhtala H, Oksa J, Valtonen R, Tiitola L, Leino T. Head movements and neck muscle activity during air combat maneuvering. Aerosp Med Hum Perform. 2020; 91(1):26-31.

Interventions to promote work ability by increasing sedentary workers' physical activity at workplaces - A scoping review.

Although worksite interventions increase physical activity, little is known about their effects on work ability. The objective of this scoping review was to examine the extent, range and nature of interventions to promote work ability by increasing the physical activity or decreasing the sedentary time of sedentary workers in order to identify implications for health promotion at workplaces. We searched Medline, Cochrane Central, and Scopus and identified 29 intervention studies. Using an iterative method, we provided an overview of the study elements and extracted details on study sample, design, intervention content, outcomes, and beneficial effects. Most of the studies (N = 25) were RCTs. Thirteen studies reported beneficial effects on work ability. Tailored and group-based interventions and interventions including environmental actions were often beneficial (9/13). We identified features of feasible and effective interventions for promoting work ability by increasing the physical activity or decreasing the sedentary time of sedentary workers. However, more studies are needed on the sustainability of these effects, and versatile interventions tailored to workers and work demands.

Effects of repeated whole-body cold exposures on serum concentrations of growth hormone, thyrotropin, prolactin and thyroid hormones in healthy women.

Cold therapy is used to relieve pain and inflammatory symptoms. Humoral changes may account for the pain alleviation related to the cold exposures. The aim of the present study was to examine the effects of two types of cold therapy, winter swimming in ice-cold water (WS) and whole body cryotherapy (WBC), on the serum levels of the growth hormone, prolactin, thyrotropin and free fractions of thyroid hormones (fT3, fT4). One group of healthy females (n = 6) was exposed to WS (water 0-2 degrees C) for 20 s and another group (n = 6) to WBC (air 110 degrees C) for 2 min, three times a week for 12 weeks. Blood samples used for the hormone measurements were taken on weeks 1, 4 and 12 before and 35 min after the cold exposures and on the days of the respective weeks, when the cold exposures were not performed. During the WS treatments, serum thyrotropin increased significantly at 35 min on weeks 1 (p < 0.01) and 4 (p < 0.05), but the responses were within the health-related reference interval. During the WS, the serum prolactin measured at 35 min on week 12 was lower than during the control treatment, and no changes in fT3 or fT4 were observed. During the WBC, no changes in the serum levels of the studied hormones were observed during the 12 weeks. In conclusion, repeated WS and WBC treatments for healthy females do not lead to disorders related to altered secretions of the growth hormone, prolactin, thyrotropin, or thyroid hormones.

Effect of local leg cooling on upper limb trajectories and muscle function and whole body dynamic balance.

This study was designed to find out if local leg cooling affects muscle function and trajectories of the upper limb during repetitive light work as well as capability to maintain dynamic balance. Nine healthy female subjects performed repetitive lifting task with right hand for 60 min while standing in front of a table with six target angles (30 degrees -220 degrees ) and with the legs inside a container with 15 degrees C cold water (Cold condition, C) or without water (Normal condition, N). Muscle temperature of the medial aspect of the gastrocnemius, rectal, and skin temperatures were measured continuously. The trajectories of the right upper limb were recorded with a 3D motion analysis system. Muscular strain (averaged EMG, a-EMG) and EMG gaps in eight muscles of the right upper limb were measured. End point excursion depicting the ability to maintain dynamic balance was measured before and after each experiment. Leg cooling decreased significantly (P < 0.05) the muscle and the mean skin temperature in C compared with N (6.7 and 2.2 degrees C, respectively). No marked changes in the trajectories or EMG activity were observed between the different environmental conditions. The end point excursion was significantly (P < 0.05) reduced in C compared with N and a positive correlation between excursion and muscle temperature was found at the end of the working period in C. In conclusion, local leg cooling did not affect upper limb muscle function or trajectories, but ability to maintain dynamic balance was reduced.

Does the diurnal increase in central temperature interact with pre-cooling or passive warm-up of the leg?

Seven male subjects volunteered to participate in an investigation of whether the diurnal increase in core temperature influences the effects of pre-cooling or passive warm-up on muscular power. Morning (07:00-09:00h) and afternoon (17:00-19:00h) evaluation of maximal power output during a cycling sprint was performed on different days in a control condition (room at 21.8 degrees C, 69% rh), after 30min of pre-cooling in a cold bath (16 degrees C), or after 30min of passive warm-up in a hot bath (38 degrees C). Despite an equivalent increase from morning to afternoon in core temperature in all conditions (+0.4 degrees C, P<0.05), power output displayed a diurnal increase in control condition only. A local cooling or heating of the leg in a neutral environment blunted the diurnal variation in muscular power. Because pre-cooling decreases muscle power, force and velocity irrespective of time-of-day, athletes should strictly avoid any cooling before a sprint exercise. In summary, diurnal variation in muscle power output seems to be more influenced by muscle rather than core temperature.

Activity Level and Body Mass Index as Predictors of Physical Workload During Working Career.

The increasing prevalence of inactivity and obesity, along with aging, has implications on work capacity of labor force. This study reports the relationships between activity level and BMI by age with objectively measured physical workload. Data were examined from a sample of 19 481 Finnish employees using an estimate of minute-to-minute oxygen consumption based on R-R interval recordings. The mean estimated %VO2max during the working day was 12.1 (±3.6) and 15.1 (±4.5)% for men and women, respectively. Based on a linear model, the mean %VO2max increased by 1.5%-unit per 10-year increase in age, by 2.1%-unit per 5 kg/m2 increase in BMI, and decreased by 1.6%-unit if improving physical activity class by two (p < 0.001 for all). Overweight and obesity, together with inactivity, notably increases workload throughout the career, even though at young adulthood, the daily workload is almost the same for each person regardless of the BMI, activity level, or gender. This study highlights the importance of regular physical activity and normal weight in protecting the worker from excessive physical (cardiovascular) workload during the whole working career.

Joint Helmet-Mounted Cueing System and Neck Muscle Activity During Air Combat Maneuvering.

BACKGROUND: The aim of the study was to determine the characteristics of cervical muscle activity in different head postures when using helmet-mounted display in one fighter vs. two aircraft air combat within visual range (WVR).METHODS: Cervical EMG was measured with eight F/A-18 pilots using the Joint Helmet Mounted Cueing System (JHMCS) during air combat maneuvering. In-flight Gz acceleration and continuous head position were recorded. EMG activity is divided and presented in a matrix with three-class rotation and five-class flexion-extension postures.RESULTS: The mean muscle activity in sternocleidomastoids and cervical extensors was 28.9% of maximal voluntary contraction (MVC) and 44.8% MVC, respectively. Cervical flexor and extensor muscles are subjected to loading over MVC during high Gz sorties. Cervical rotation combined with extension exceeded muscle force-producing capacity during high Gz, resulting in a decline in muscle activity.DISCUSSION: Awkward postures, especially rotational ones, are more prone to increase loading over muscles' capacity. Overloading of muscles increases the risk of muscular and ligamentous injury. In addition, the lack of muscular support potentially leads to the Gz loading being transferred to spinal structures via intervertebral discs and the vertebral column. The JHMCS helmet seems to change the pattern of most loading muscles toward the extensor (posterior) neck muscles.Sovelius R, Mäntylä M, Heini H, Oksa J, Valtonen R, Tiitola L, Leino T. Joint helmet-mounted cueing system and neck muscle activity during air combat maneuvering. Aerosp Med Hum Perform. 2019; 90(10):834-840.

Gait muscle activity during walking on an inclined icy surface.

The objective of this study was to explain the contribution of lower extremity muscle activity to gait kinetic and kinematic adaptations for maintaining gait dynamic balance when walking on an inclined icy surface and the biomechanical mechanisms used to counteract slip risk. A two-way factorial experimental design was applied. The two independent variables were the walkway surface (ice and treadmill) and the walkway inclination (0 masculine, 6 masculine, 8 masculine). The dependent variable was the amplitude of the surface EMG of four right lower extremity muscles (tibialis anterior TA, gastrocnemius lateralis GL, rectus femoris RF, and biceps femoris BF). Twelve healthy subjects (7 males and 5 females) participated in the walking trials. A two-way ANOVA analysis showed that on the icy surface in the heel contact phase, EMG amplitudes significantly decreased in TA and RF compared to those for the treadmill surface. In the mid-stance phase, the GL muscle activity significantly decreased on ice compared to treadmill and all four muscle activities increased significantly with the inclination. During the toe off phase, GL and RF activities increased with the inclination. The mechanisms identified may be applied to develop intervention, rehabilitation and training techniques, and to improve performance in human locomotion, such as for winter sports.

Neck and back muscle loading in pilots flying high G(z) sorties with and without lumbar support.

INTRODUCTION: Fighter pilots frequently encounter neck and back pain and injuries due to high G(z) loading. A lumbar support could diminish muscle strain in the lower back under G(z) loading and might also have a positive effect on cervical muscle strain, due to a more ergonomic sitting posture. The aim of this study was to determine the effects of individually adjusted lumbar supports on fighter pilots' neck and back muscle loadings. METHODS: There were 11 Finnish Air Force pilots who acted as test subjects. They flew two basic air combat maneuvering sorties with and without the LS. The EMG activity of the sternocleidomastoid (SCM), cervical (CES), thoracic (TES), and lumbar erector spinae muscles (LES) were measured during these sorties, and the number and duration of EMG gaps was analyzed. Subjective experiences about the lumbar support were evaluated using a questionnaire. RESULTS: In all measured muscles, mean percent maximal voluntary contraction (%MVC) was lower when the LS was used, yet these changes were not statistically significant. Individual differences in %MVC between flights diminished in the CES (9%), TES (7%), and LES (8%) with LS in use. There was also a tendency toward increased number of gaps in EMG activity when flying with the LS. According to questionnaire responses, the LS seems to relieve in-flight symptoms and reduce the fatigue in the lower back muscles. Not all subjects benefited from the LS, however. CONCLUSION: There seems to be a tendency toward a lower muscle strain with the LS, but there are considerable individual differences.

Neck muscle strain when wearing helmet and NVG during acceleration on a trampoline.

INTRODUCTION: The helmet-mounted equipment worn by military pilots increases the weight of the helmet system and shifts its center of gravity, increasing the loads on neck structures, especially during acceleration. The aim of this study was to determine neck muscle strain with different head-loads during trampoline-induced G loads (0 to +4 G). METHODS: Under three conditions [no helmet, helmet, helmet with night vision goggles (NVG)], 14 subjects performed trampoline exercises including basic, hand-and-knee, and back bouncing. EMG activity was measured for the sternocleidomastoid (SCM), cervical erector spinae (CES), trapezoid (TRA), and thoracic erector spinae (TES) muscles. Muscle strain was determined as a percentage of maximal voluntary contraction (%MVC). RESULTS: For the three exercises combined, the following significant changes were found: compared to control, the helmet increased muscle strain by 18%, 28%, and 18% in the SCM, CES, and TRA, respectively; NVG produced a further increase of 11% in the SCM and 6% in the CES. During back bouncing, the helmet increased muscle strain by 14% in the SCM and 19% in the CES, and NVG further increased this strain by 14% in the SCM. Hand-and-knee bouncing loaded extensors: the helmet caused increases of 46% in the CES and 29% in the TES, while NVG produced a further 13% increase in CES activation. CONCLUSION: Helmet weight alone had a large effect on muscular workload. The additional frontal weight of the NVG caused a further increase in the activity of cervical muscles that were already subjected to high strain.