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Komisar V, Novak AC. Effect of Handrail Height and Age on Trunk and Shoulder Kinematics Following Perturbation-Evoked Grasping Reactions During Gait. HUMAN FACTORS 2023; 65:200-211. [PMID: 33945338 PMCID: PMC9969491 DOI: 10.1177/00187208211013631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 04/06/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE To characterize the effect of handrail height and age on trunk and shoulder kinematics, and concomitant handrail forces, on balance recovery reactions during gait. BACKGROUND Falls are the leading cause of unintentional injury in adults in North America. Handrails can significantly enhance balance recovery and help individuals to avoid falls, provided that their design allows users across the lifespan to reach and grasp the rail after balance loss, and control their trunk by applying hand-contact forces to the rail. However, the effect of handrail height and age on trunk and shoulder kinematics when recovering from perturbations during gait is unknown. METHOD Fourteen younger and 13 older adults experienced balance loss (sudden platform translations) while walking beside a height-adjustable handrail. Handrail height was varied from 30 to 44 inches (76 to 112 cm). Trunk and shoulder kinematics were measured via 3D motion capture; applied handrail forces were collected from load cells mounted to the rail. RESULTS As handrail height increased (up to 42 inches/107 cm), peak trunk angular displacement and velocity generally decreased, while shoulder elevation angles during reaching and peak handrail forces did not differ significantly between 36 and 42 inches (91 and 107 cm). Age was associated with reduced peak trunk angular displacements, but did not affect applied handrail forces. CONCLUSION Higher handrails (up to 42 inches) may be advantageous for trunk control when recovering from destabilizations during gait. APPLICATION Our results can inform building codes, workplace safety standards, and accessibility standards, for safer handrail design.
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Affiliation(s)
- Vicki Komisar
- University of British Columbia, Kelowna, Canada
- Toronto Rehabilitation Institute – University Health Network,
ON, Canada
- University of Toronto, ON, Canada
| | - Alison C. Novak
- Toronto Rehabilitation Institute – University Health Network,
ON, Canada
- University of Toronto, ON, Canada
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Kantha P, Hsu WL, Chen PJ, Tsai YC, Lin JJ. A novel balance training approach: Biomechanical study of virtual reality-based skateboarding. Front Bioeng Biotechnol 2023; 11:1136368. [PMID: 36845193 PMCID: PMC9950389 DOI: 10.3389/fbioe.2023.1136368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 01/26/2023] [Indexed: 02/12/2023] Open
Abstract
Introduction: The use of virtual reality (VR) technology in training and rehabilitation gained increasing attention in recent years due to its potential to provide immersive and interactive experiences. We developed a novel VR-based balance training, VR-skateboarding, for improving balance. It is important to investigate the biomechanical aspects of this training, as it would have benefited both health professionals and software engineers. Aims: This study aimed to compare the biomechanical characteristics of VR-skateboarding with those of walking. Materials and Methods: Twenty young participants (10 males and 10 females) were recruited. Participants underwent VR-skateboarding and walking at the comfortable walking speed, with the treadmill set at the same speed for both tasks. The motion capture system and electromyography were used to determine joint kinematics and muscle activity of the trunk and legs, respectively. The force platform was also used to collect the ground reaction force. Results: Participants demonstrated increased trunk flexion angles and muscle activity of trunk extensor during VR-skateboarding than during walking (p < 0.01). For the supporting leg, participants' joint angles of hip flexion and ankle dorsiflexion, as well as muscle activity of knee extensor, were higher during VR-skateboarding than during walking (p < 0.01). For the moving leg, only hip flexion increased in VR-skateboarding when compared to walking (p < 0.01). Furthermore, participants increased weight distribution in the supporting leg during VR-skateboarding (p < 0.01). Conclusion: VR-skateboarding is a novel VR-based balance training that has been found to improve balance through increased trunk and hip flexion, facilitated knee extensor muscles, and increased weight distribution on the supporting leg compared to walking. These differences in biomechanical characteristics have potential clinical implications for both health professionals and software engineers. Health professionals may consider incorporating VR-skateboarding into training protocols to improve balance, while software engineers may use this information to design new features in VR systems. Our study suggests that the impact of VR-skateboarding particularly manifest when focusing on the supporting leg.
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Affiliation(s)
- Phunsuk Kantha
- School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Wei-Li Hsu
- School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan,Physical Therapy Center, National Taiwan University Hospital, Taipei, Taiwan,*Correspondence: Wei-Li Hsu,
| | - Po-Jung Chen
- School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Yi-Ching Tsai
- School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Jiu-Jenq Lin
- School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan,Division of Physical Therapy, Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei, Taiwan
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Gosine P, Komisar V, Novak AC. The effect of handrail cross-sectional design and age on applied handrail forces during reach-to-grasp balance reactions. J Biomech 2021; 129:110788. [PMID: 34666247 DOI: 10.1016/j.jbiomech.2021.110788] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 09/28/2021] [Accepted: 09/29/2021] [Indexed: 11/16/2022]
Abstract
Handrails have been shown to reduce the likelihood of falls. Despite common use, little is known about how handrail shape and size affect the forces that people can apply after balance loss, and how these forces and the corresponding ability to recover balance depend on age. Following rapid platform translations, 16 older adults and 16 sex-matched younger adults recovered their balance using seven handrail cross-sections varying in shape and size. Younger adults were able to withstand higher perturbations, but did not apply higher forces, than older adults. However, younger adults achieved their peak resultant force more quickly, which may reflect slower rates of force generation with older adults. Considering handrail design, the 38 mm round handrails allowed participants to successfully recover from the largest perturbations and enabled the highest force generation. Conversely, tapered handrails had the poorest performance, resulting in the lowest force generation and withstood perturbation magnitudes. Our findings suggest that the handrail cross-sectional design affects the magnitude of force generation and may impact the success of recovery. Our findings can inform handrail design recommendations that support effective handrail use in demanding, balance recovery scenarios.
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Affiliation(s)
- Philippa Gosine
- KITE Research Institute, Toronto Rehabilitation Institute - University Health Network, 550 University Avenue - Room 13-000, Toronto, Ontario M5G 2A2, Canada; Institute of Biomaterials and Biomedical Engineering, University of Toronto, 164 College Street- Room 407, Toronto, Ontario M5S 3G9, Canada
| | - Vicki Komisar
- School of Engineering, University of British Columbia, 1137 Alumni Ave, Kelowna, British Columbia V1V 1V7, Canada
| | - Alison C Novak
- KITE Research Institute, Toronto Rehabilitation Institute - University Health Network, 550 University Avenue - Room 13-000, Toronto, Ontario M5G 2A2, Canada; Faculty of Kinesiology and Physical Education, University of Toronto, 55 Harbord Street, Toronto, Ontario M5S 2W8, Canada; Department of Occupational Science and Occupational Therapy, University of Toronto, 500 University Avenue - Room 160, Toronto, Ontario M5G 1V7, Canada.
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Komisar V, Robinovitch SN. The Role of Fall Biomechanics in the Cause and Prevention of Bone Fractures in Older Adults. Curr Osteoporos Rep 2021; 19:381-390. [PMID: 34105101 DOI: 10.1007/s11914-021-00685-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/22/2021] [Indexed: 02/07/2023]
Abstract
PURPOSE OF REVIEW Adults over age 65 experience the highest rates of bone fracture, and 90% of fractures in older adults are caused by falls from standing height or lower. Advances in fracture prevention rely on our ability to prevent falls, reduce the severity of falls, and enhance the resistance of bone to trauma. To help guide these efforts, we need improved understanding on the types of falls that cause fractures. RECENT FINDINGS In this review, we describe recent evidence on how the mechanics of falls in older adults influence the risk for fractures to the hip, wrist, vertebrae, and humerus. We discuss how fracture risk depends on fall height, fall direction, and landing configuration. We also review the benefits of exercise, wearable protective gear, and environmental modifications in preventing fractures in older adults. Our findings highlight promising new directions in fracture prevention, and the need for collaboration between the bone and falls research communities to implement proven strategies and generate new solutions.
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Affiliation(s)
- Vicki Komisar
- School of Engineering, The University of British Columbia, Kelowna, BC, Canada
| | - Stephen Neil Robinovitch
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, BC, Canada.
- School of Engineering Science, Simon Fraser University, 8888 University Drive, Burnaby, BC, V5A 1S6, Canada.
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Luna TD, Santamaria V, Omofuma I, Khan MI, Agrawal SK. Postural Control Strategies in Standing With Handrail Support and Active Assistance From Robotic Upright Stand Trainer (RobUST). IEEE Trans Neural Syst Rehabil Eng 2021; 29:1424-1431. [PMID: 34264829 DOI: 10.1109/tnsre.2021.3097301] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
In people with severe neuromotor deficits of trunk and lower extremities, regaining balance in standing is often performed in rehabilitation with manual assistance, rigid body supports or by the use of handrails. To investigate and further expand postural control training in standing, we developed a Robotic Upright Stand Trainer (RobUST). In this study, we used RobUST to deliver trunk perturbations while simultaneously providing postural assistive forces on the pelvis in 10 able-bodied adults. Posture control responses with 'pelvic support' was then compared to 'no support' and 'hand supported' standing, with and without assistance from RobUST. We characterize postural imbalance with kinematic displacements and center of pressure (COP) outcomes, such as amplitude and root mean square of the excursions of COP. Surface electromyography (sEMG) was also applied to investigate muscle control. We additionally investigated ground reaction and handrail forces during standing to analyze how postural strategies and muscle mechanisms with 'pelvic support' via RobUST would differ from standing with 'no support' and with the 'handrail support'. Our results show that during perturbations, pelvic assistive support decreased kinematic and COP excursions compared to standing with no support. The pelvic assistance from RobUST showed similar level of COP changes as the use of handrail support but without reducing muscle activity or ground reaction forces. As expected, the maximum level of postural stability was observed when participants used the handrail and received pelvic assistive forces. In conclusion, RobUST demonstrates potential as a training device since it enhances postural balance without significantly removing muscular control mechanisms that are of interest in re-training postural control strategies in standing.
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Gosine P, Komisar V, Novak AC. A kinematic analysis of balance recovery following an unexpected forward balance loss during stair descent. APPLIED ERGONOMICS 2021; 92:103317. [PMID: 33296842 DOI: 10.1016/j.apergo.2020.103317] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 11/09/2020] [Accepted: 11/12/2020] [Indexed: 06/12/2023]
Abstract
Falls during stair descent pose a major health concern. A stronger understanding of recovery from balance loss during stair descent is needed to guide fall prevention strategies and environmental design. We characterized balance recovery strategies, trunk and center-of-mass (COM) kinematics, and handrail use following unexpected forward balance loss during stair descent, and the effect of perturbation magnitude on these outcomes. Eighteen young adults experienced a rapid platform translation during stair descent to disrupt balance. Deception was used to reduce anticipation. All participants used compensatory stepping to recover balance, and most applied forces to the handrail in multiple directions. Higher perturbation magnitude resulted in higher COM velocity and handrail forces, more frequent incomplete steps, and quicker step contact time. Our findings provide a foundation for understanding balance recovery on stairs. The findings emphasize the importance of designing stairways that enable compensatory stepping, and handrails that permit adequate force generation in multiple directions to facilitate balance recovery on stairs.
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Affiliation(s)
- Philippa Gosine
- KITE Research Institute, Toronto Rehabilitation Institute - University Health Network, 550 University Avenue - Room 13-000, Toronto, Ontario, M5G 2A2, Canada; Institute of Biomedical Engineering, University of Toronto, 164 College Street- Room 407, Toronto, Ontario, M5S 3G9, Canada
| | - Vicki Komisar
- KITE Research Institute, Toronto Rehabilitation Institute - University Health Network, 550 University Avenue - Room 13-000, Toronto, Ontario, M5G 2A2, Canada; Department of Biomedical Physiology and Kinesiology, Simon Fraser University, 8888 University Drive, Burnaby, British Columbia, V5A 1S6, Canada; School of Engineering, University of British Columbia, 1137 Alumni Ave, Kelowna, British Columbia, V1V 1V7, Canada
| | - Alison C Novak
- KITE Research Institute, Toronto Rehabilitation Institute - University Health Network, 550 University Avenue - Room 13-000, Toronto, Ontario, M5G 2A2, Canada; Faculty of Kinesiology and Physical Education, University of Toronto, 55 Harbord Street, Toronto, Ontario, M5S 2W8, Canada; Department of Occupational Science and Occupational Therapy, University of Toronto, 500 University Avenue - Room 160, Toronto, Ontario, M5G 1V7, Canada.
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Pliner EM, Novak AC, Beschorner KE. Hand-rung forces after a ladder climbing perturbation. J Biomech 2020; 106:109790. [PMID: 32517996 DOI: 10.1016/j.jbiomech.2020.109790] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 04/05/2020] [Indexed: 10/24/2022]
Abstract
The hands are believed to be important for arresting falls from ladders. Yet, there is a paucity of kinetic data for the hand-handhold interface during recovery from a ladder climbing perturbation. This study quantified the hand-rung forces utilized after ladder climbing perturbations and the factors (upper body strength, fall severity, reestablished foot placement) contributing to hand-rung force. A ladder rung was released under the foot of the participants to simulate a climbing misstep perturbation. Hand-rung forces after the perturbation were quantified from load cells connected to two ladder rungs. Mean peak hand-rung force magnitudes were found to range between 46% and 84% of the climber's body weight. These magnitudes approached and, in some cases, exceeded individuals' grasping capacity. Individual upper body strength was not found to consistently contribute to hand-rung force, but increased hand-rung force was clearly linked with greater fall severity after an ascending perturbation. Individuals that reestablished foot placement after an ascending perturbation utilized lower hand-rung forces. Therefore, this study suggests hand-rung force to be dependent on circumstances of the falling event (fall severity, reestablished foot placement) as opposed to the climber's capability of producing upper body force. This knowledge highlights the importance of handhold and ladder designs for arresting a falling event, and is critical to inform ladder fall interventions such as designing handholds that resist high forces and permitting steps that enable reestablished foot placement.
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Affiliation(s)
| | - Alison C Novak
- Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada.
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Extending the center of pressure to incorporate handhold forces: Derivation and sample application. J Biomech 2020; 104:109727. [DOI: 10.1016/j.jbiomech.2020.109727] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Revised: 02/25/2020] [Accepted: 02/25/2020] [Indexed: 11/21/2022]
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Gosine P, Komisar V, Novak AC. Characterizing the demands of backward balance loss and fall recovery during stair descent to prevent injury. APPLIED ERGONOMICS 2019; 81:102900. [PMID: 31422249 DOI: 10.1016/j.apergo.2019.102900] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Revised: 07/10/2019] [Accepted: 07/12/2019] [Indexed: 06/10/2023]
Abstract
Understanding the demands of balance recovery on stairs is important for developing strategies to prevent falls on stairs. This study characterized recovery strategies and whole-body movement following unexpected backward balance loss during stair descent in twelve young adults. Following balance loss, peak downward COM velocity was approximately double that experienced during non-perturbation stair descent. Participants used several balance recovery strategies: harness reliance (n = 1), no grasping reaction (n = 3), and grasping some environmental feature (n = 8). Of the five participants who used the handrail, four demonstrated grasping errors. Peak resultant handrail forces ranged from 24.2N to 238.3N. The results highlight the challenge of balance recovery during stair descent, showing that some people will use any available surface to arrest a fall. Our findings serve as a benchmark to understand the impact of stair-related interventions on fall recovery.
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Affiliation(s)
- Philippa Gosine
- KITE, Toronto Rehabilitation Institute, University Health Network, 13-000, 550 University Avenue, Toronto, Ontario, M5G 2A2, Canada; Institute of Biomaterials and Biomedical Engineering, University of Toronto, 164 College Street - Room 407, Toronto, Ontario, M5S 3G9, Canada
| | - Vicki Komisar
- KITE, Toronto Rehabilitation Institute, University Health Network, 13-000, 550 University Avenue, Toronto, Ontario, M5G 2A2, Canada; Department of Biomedical Physiology and Kinesiology, Simon Fraser University, 8888 University Drive, Burnaby, British Columbia, V5A 1S6, Canada
| | - Alison C Novak
- KITE, Toronto Rehabilitation Institute, University Health Network, 13-000, 550 University Avenue, Toronto, Ontario, M5G 2A2, Canada; Faculty of Kinesiology and Physical Education, University of Toronto, 55 Harbord Street, Toronto, Ontario, M5S 2W8, Canada; Department of Occupational Science and Occupational Therapy, University of Toronto, 500 University Avenue - Room 160, Toronto, Ontario, M5G 1V7, Canada.
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Komisar V, Maki BE, Novak AC. Effect of handrail height and age on the timing and speed of reach-to-grasp balance reactions during slope descent. APPLIED ERGONOMICS 2019; 81:102873. [PMID: 31422250 DOI: 10.1016/j.apergo.2019.102873] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Revised: 05/04/2019] [Accepted: 06/06/2019] [Indexed: 06/10/2023]
Abstract
We investigated the effect of handrail height on the timing and speed of reach-to-grasp balance reactions during slope descent, in fourteen younger and thirteen older adults. Participants walked along an 8° slope mounted to a robotic platform. Platform perturbations evoked reach-to-grasp reactions. Handrail height did not significantly affect handrail contact time (i.e., time from perturbation onset to handrail contact) or movement time (i.e., time from EMG latency to handrail contact). Participants appeared to compensate for the increased hand-handrail distance with higher rails via increased peak upward hand speed, and decreased vertical handrail overshoot. Aging was associated with slower EMG latency, reduced hand acceleration time, and increased hand deceleration time. Our findings suggest that participants were not disadvantaged by higher handrails from reach-to-grasp timing or speed perspectives, and that other metrics (e.g., center-of-mass control after grasping) may be more important when evaluating handrail designs for balance recovery.
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Affiliation(s)
- Vicki Komisar
- Toronto Rehabilitation Institute - University Health Network, 13-000, 550 University Avenue, Toronto, ON, M5G 2A2, Canada; Institute of Biomaterials and Biomedical Engineering, University of Toronto, 164 College Street - Room 407, Toronto, ON, M5S 3G9, Canada; Department of Biomedical Physiology and Kinesiology, Simon Fraser University, 8888 University Drive, Burnaby, British Columbia, Canada.
| | - Brian E Maki
- Toronto Rehabilitation Institute - University Health Network, 13-000, 550 University Avenue, Toronto, ON, M5G 2A2, Canada; Institute of Biomaterials and Biomedical Engineering, University of Toronto, 164 College Street - Room 407, Toronto, ON, M5S 3G9, Canada; Institute of Medical Sciences, University of Toronto, 1 King's College Circle - Room 2374, Toronto, ON, M5S 1A8, Canada; Department of Surgery, University of Toronto, 149 College Street, 5th Floor, Toronto, ON, M5T 1P5, Canada
| | - Alison C Novak
- Toronto Rehabilitation Institute - University Health Network, 13-000, 550 University Avenue, Toronto, ON, M5G 2A2, Canada; Department of Occupational Science and Occupational Therapy, University of Toronto, 500 University Avenue - Room 160, Toronto, ON, M5G 1V7, Canada; Faculty of Kinesiology and Physical Education, University of Toronto, 55 Harbord Street, Toronto, ON, M5S 2W8, Canada
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Komisar V, McIlroy WE, Duncan CA. Individual, task, and environmental influences on balance recovery: a narrative review of the literature and implications for preventing occupational falls. IISE Trans Occup Ergon Hum Factors 2019. [DOI: 10.1080/24725838.2019.1634160] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- Vicki Komisar
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, BC, Canada.
| | | | - Carolyn A. Duncan
- Department of Kinesiology and Integrative Physiology, Michigan Technological University, Houghton, MI
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