Reduced oxygen cost of running is related to alignment of the resultant GRF and leg axis vector: A pilot study

The Relationship Between Running Biomechanics and Running Economy: A Systematic Review and Meta-Analysis of Observational Studies

BACKGROUND

Running biomechanics is considered an important determinant of running economy (RE). However, studies examining associations between running biomechanics and RE report inconsistent findings.

OBJECTIVE

The aim of this systematic review was to determine associations between running biomechanics and RE and explore potential causes of inconsistency.

METHODS

Three databases were searched and monitored up to April 2023. Observational studies were included if they (i) examined associations between running biomechanics and RE, or (ii) compared running biomechanics between groups differing in RE, or (iii) compared RE between groups differing in running biomechanics during level, constant-speed, and submaximal running in healthy humans (18-65 years). Risk of bias was assessed using a modified tool for observational studies and considered in the results interpretation using GRADE. Meta-analyses were performed when two or more studies reported on the same outcome. Meta-regressions were used to explore heterogeneity with speed, coefficient of variation of height, mass, and age as continuous outcomes, and standardization of running shoes, oxygen versus energetic cost, and correction for resting oxygen or energy cost as categorical outcomes.

RESULTS

Fifty-one studies (n = 1115 participants) were included. Most spatiotemporal outcomes showed trivial and non-significant associations with RE: contact time r = - 0.02 (95% confidence interval [CI] - 0.15 to 0.12); flight time r = 0.11 (- 0.09 to 0.32); stride time r = 0.01 (- 0.8 to 0.50); duty factor r = - 0.06 (- 0.18 to 0.06); stride length r = 0.12 (- 0.15 to 0.38), and swing time r = 0.12 (- 0.13 to 0.36). A higher cadence showed a small significant association with a lower oxygen/energy cost (r = - 0.20 [- 0.35 to - 0.05]). A smaller vertical displacement and higher vertical and leg stiffness showed significant moderate associations with lower oxygen/energy cost (r = 0.35, - 0.31, - 0.28, respectively). Ankle, knee, and hip angles at initial contact, midstance or toe-off as well as their range of motion, peak vertical ground reaction force, mechanical work variables, and electromyographic activation were not significantly associated with RE, although potentially relevant trends were observed for some outcomes.

CONCLUSIONS

Running biomechanics can explain 4-12% of the between-individual variation in RE when considered in isolation, with this magnitude potentially increasing when combining different variables. Implications for athletes, coaches, wearable technology, and researchers are discussed in the review.

PROTOCOL REGISTRATION

https://doi.org/10.17605/OSF.IO/293 ND (OpenScience Framework).

The biomechanics of running and running styles: a synthesis

Running movements are parametrised using a wide variety of devices. Misleading interpretations can be avoided if the interdependencies and redundancies between biomechanical parameters are taken into account. In this synthetic review, commonly measured running parameters are discussed in relation to each other, culminating in a concise, yet comprehensive description of the full spectrum of running styles. Since the goal of running movements is to transport the body centre of mass (BCoM), and the BCoM trajectory can be derived from spatiotemporal parameters, we anticipate that different running styles are reflected in those spatiotemporal parameters. To this end, this review focuses on spatiotemporal parameters and their relationships with speed, ground reaction force and whole-body kinematics. Based on this evaluation, we submit that the full spectrum of running styles can be described by only two parameters, namely the step frequency and the duty factor (the ratio of stance time and stride time) as assessed at a given speed. These key parameters led to the conceptualisation of a so-called Dual-axis framework. This framework allows categorisation of distinctive running styles (coined 'Stick', 'Bounce', 'Push', 'Hop', and 'Sit') and provides a practical overview to guide future measurement and interpretation of running biomechanics.

Assessing spring-mass similarity in elite and recreational runners

The dynamic complexity and individualization of running biomechanics has challenged the development of objective and comparative gait measures. Here, we present and explore several novel biomechanical metrics for running that are informed by a canonical inter-species gait template-the spring-mass model. The measures assess running mechanics systemically against the template via quantifying characteristics of a runner's kinetics relative to the energy-conserving elastic system-i.e., their "spring-mass similarity". Applying these metrics in a retrospective cohort investigation, we studied the overground kinetics of two heterogenous populations of runners in two footwear conditions: elite and recreational athletes in shod and barefoot conditions. Across all measures and within foot strike types, the elite runners exhibited mechanics that were more similar to those of the ideally elastic spring-mass template. The elite runners had more symmetric bounces, less discrepancy (i.e., greater coordination) between horizontal and vertical kinetic changes, and better fit to a spring-mass vertical ground reaction force time series. Barefoot running elicited greater kinetic coordination in the recreational runners. At a faster speed, the elites further improved their similarity to the template. Overall, the more economical elite group exhibited greater likeness to the linearly elastic, energy-conserving spring-mass system than their recreational counterparts. This study introduces novel biomechanical measures related to performance in distance running. More broadly, it provides new, approachable metrics for systemic quantification of gait biomechanics in runners across all demographics. These metrics may be applied to assess a runner's global biomechanical response to a variety of interventions, including training adaptations, rehabilitation programs, and footwear conditions.

Effects of footwear with different longitudinal bending stiffness on biomechanical characteristics and muscular mechanics of lower limbs in adolescent runners

Background: Running shoes with carbon plates have been identified to have positive effects on improving running performance from a biomechanical perspective. However, the specific difference between the effects of carbon plates with different longitudinal bending stiffness (LBS)on biomechanical characteristics and muscular mechanics of lower limbs in adolescent runners remains unclear. This study aimed to identify the difference in biomechanical characteristics and muscular mechanics in lower limbs during running stance phases between wearing shoes with low longitudinal bending stiffness (Llbs) and high longitudinal bending stiffness (Hlbs) carbon plates in adolescent runners. Methods: 10 male adolescent runners with a habit of daily running exercise (age: 13.5 ± 0.6 years; height: 166.3 ± 1.9 cm; bodyweight: 50.8 ± 3.1 kg; foot length: 25.4 ± 0.2 cm) were recruited and asked to conduct two times of tests by wearing shoes with Llbs and Hlbs carbon plates in a randomized order. Paired t-test and statistical parametric mapping (SPM) analysis were used to identify the difference in biomechanical characteristics and muscular mechanics in lower limbs during running stance phases. Result: Under the condition of wearing shoes with Hlbs, the time of foot contact significantly increased, whereas the range of motion (ROM) of hip and metatarsophalangeal (MTP) in the sagittal plane significantly reduced as well as the peak moment of ankle joint in the sagittal plane. The activations of vastus medialis, vastus lateralis, flexor digitorum brevis (flex dig brevis), and flexor hallucis longus (flex hall long) significantly increased under the condition of wearing shoes with Hlbs. According to the results of the SPM analysis, the joint angles (hip, ankle, and MTP), the net joint moments (knee, ankle, and MTP), and the muscle forces (gluteus maximus and tibialis anterior) were significant difference during the running stance phase between conditions of wearing shoes with Hlbs and Llbs. Conclusion: Running shoes with Llb carbon plates are appropriate for adolescent runners due to the advantages of biomechanical characteristics and muscular mechanics.

Examination of running pattern consistency across speeds

Duty factor (DF) and step frequency (SF) are key running pattern determinants. However, running patterns may change with speed if DF and SF changes are inconsistent across speeds. We examined whether the relative positioning of runners was consistent: 1) across five running speeds (10-18 km/h) for four temporal variables [DF, SF, and their subcomponents: contact (t c ) and flight (t f ) time]; and 2) across these four temporal variables at these five speeds. Three-dimensional whole-body kinematics were acquired from 52 runners, and deviations from the median for each variable (normalised to minimum-maximum values) were extracted. Across speeds for all variables, correlations on the relative positioning of individuals were high to very high for 2-4 km/h speed differences, and moderate to high for 6-8 km/h differences. Across variables for all speeds, correlations were low between DF-SF, very high between DF-t f , and low to high between DF-t c , SF-t c , and SF-t f . Hence, the consistency in running patterns decreased as speed differences increased, suggesting that running patterns be assessed using a range of speeds. Consistency in running patterns at a given speed was low between DF and SF, corroborating suggestions that using both variables can encapsulate the full running pattern spectrum.

Non-South East Asians have a better running economy and different anthropometrics and biomechanics than South East Asians

Running biomechanics and ethnicity can influence running economy (RE), which is a critical factor of running performance. Our aim was to compare RE of South East Asian (SEA) and non-South East Asian (non-SEA) runners at several endurance running speeds (10-14 km/h) matched for on-road racing performance and sex. Secondly, we explored anthropometric characteristics and relationships between RE and anthropometric and biomechanical variables. SEA were 6% less economical (p = 0.04) than non-SEA. SEA were lighter and shorter than non-SEA, and had lower body mass indexes and leg lengths (p ≤ 0.01). In terms of biomechanics, a higher prevalence of forefoot strikers in SEA than non-SEA was seen at each speed tested (p ≤ 0.04). Furthermore, SEA had a significantly higher step frequency (p = 0.02), shorter contact time (p = 0.04), smaller footstrike angle (p < 0.001), and less knee extension at toe-off (p = 0.03) than non-SEA. Amongst these variables, only mass was positively correlated to RE for both SEA (12 km/h) and non-SEA (all speeds); step frequency, negatively correlated to RE for both SEA (10 km/h) and non-SEA (12 km/h); and contact time, positively correlated to RE for SEA (12 km/h). Despite the observed anthropometric and biomechanical differences between cohorts, these data were limited in underpinning the observed RE differences at a group level. This exploratory study provides preliminary indications of potential differences between SEA and non-SEA runners warranting further consideration. Altogether, these findings suggest caution when generalizing from non-SEA running studies to SEA runners.

Mechanics, energetics and implementation of grounded running technique: a narrative review

Grounded running predominantly differs from traditional aerial running by having alternating single and double stance with no flight phase. Approximately, 16% of runners in an open marathon and 33% of recreational runners in a 5 km running event adopted a grounded running technique. Grounded running typically occurs at a speed range of 2–3 m·s⁻¹, is characterised by a larger duty factor, reduced vertical leg stiffness, lower vertical oscillation of the centre of mass (COM) and greater impact attenuation than aerial running. Grounded running typically induces an acute increase in metabolic cost, likely due to the larger duty factor. The increased duty factor may translate to a more stable locomotion. The reduced vertical oscillation of COM, attenuated impact shock, and potential for improved postural stability may make grounded running a preferred form of physical exercise in people new to running or with low loading capacities (eg, novice overweight/obese, elderly runners, rehabilitating athletes). Grounded running as a less impactful, but metabolically more challenging form, could benefit these runners to optimise their cardio-metabolic health, while at the same time minimise running-related injury risk. This review discusses the mechanical demands and energetics of grounded running along with recommendations and suggestions to implement this technique in practice.

Stride-to-Stride Variability of the Center of Mass in Male Trained Runners After an Exhaustive Run: A Three Dimensional Movement Variability Analysis With a Subject-Specific Anthropometric Model

The motion of the human body can be described by the motion of its center of mass (CoM). Since the trajectory of the CoM is a crucial variable during running, one can assume that trained runners would try to keep their CoM trajectory constant from stride to stride. However, when exposed to fatigue, runners might have to adapt certain biomechanical parameters. The Uncontrolled Manifold approach (UCM) and the Tolerance, Noise, and Covariation (TNC) approach are used to analyze changes in movement variability while considering the overall task of keeping a certain task relevant variable constant. The purpose of this study was to investigate if and how runners adjust their CoM trajectory during a run to fatigue at a constant speed on a treadmill and how fatigue affects the variability of the CoM trajectory. Additionally, the results obtained with the TNC approach were compared to the results obtained with the UCM analysis in an earlier study on the same dataset. Therefore, two TNC analyses were conducted to assess effects of fatigue on the CoM trajectory from two viewpoints: one analyzing the CoM with respect to a lab coordinate system (PVlab) and another one analyzing the CoM with respect to the right foot (PVfoot). Full body kinematics of 13 healthy young athletes were captured in a rested and in a fatigued state and an anthropometric model was used to calculate the CoM based on the joint angles. Variability was quantified by the coefficient of variation of the length of the position vector of the CoM and by the components Tolerance, Noise, and Covariation which were analyzed both in 3D and the projections in the vertical, anterior-posterior and medio-lateral coordinate axes. Concerning PVlab we found that runners increased their stride-to-stride variability in medio-lateral direction (1%). Concerning PVfoot we found that runners lowered their CoM (4 mm) and increased their stride-to-stride variability in the absorption phase in both 3D and in the vertical direction. Although we identified statistically relevant differences between the two running states, we have to point out that the effects were small (CV ≤ 1%) and must be interpreted cautiously.

Duty Factor Reflects Lower Limb Kinematics of Running

The aim was to identify the differences in lower limb kinematics used by high (DFhigh) and low (DFlow) duty factor (DF) runners, particularly their sagittal plane (hip, knee, and ankle) joint angles and pelvis and foot segment angles during stance. Fifty-nine runners were divided in two DF groups based on their mean DF measured across a range of speeds. Temporal characteristics and whole-body three-dimensional kinematics of the running step were recorded from treadmill runs at 8, 10, 12, 14, 16, and 18 km/h. Across speeds, DFhigh runners, which limit vertical displacement of the COM and promote forward propulsion, exhibited more lower limb flexion than DFlow during the ground contact time and were rearfoot strikers. On the contrary, DFlow runners used a more extended lower limb than DFhigh due to a stiffer leg and were midfoot and forefoot strikers. Therefore, two different lower limb kinematic mechanisms are involved in running and the one of an individual is reflected by the DF.

Effect of Forefoot and Midfoot Bending Stiffness on Agility Performance and Foot Biomechanics in Soccer

Footwear bending stiffness is known to positively affect performance in agility maneuvers due to improved energy storage and propulsion based on a stiffer foot-shoe complex. However, the functional properties of the forefoot and midfoot differ. Therefore, the present study investigates the effect of the interface of longitudinal bending stiffness and the ratio of forefoot to midfoot bending stiffness on agility performance and foot biomechanics. A total of 18 male soccer players performed 2 agility tasks in footwear conditions that were systematically modified in forefoot and midfoot bending stiffness. Results revealed that higher longitudinal bending stiffness caused more foot exorotation at the initial ground contact (P < .05), less torsion (P < .001), and an anterior shift in the point of force application during push off (P = .01). In addition, the authors observed decreased forefoot bending (P < .05) and increased torsion (P < .01) in footwear with a higher forefoot-midfoot ratio. Finally, the agility performance was significantly impaired by 1.3% in the condition with the highest forefoot-midfoot ratio (P < .01). The high forefoot-midfoot ratio, that is, a stiff forefoot in combination with a soft midfoot, seemed to shift the flex line from anterior to posterior that may explain the performance impairment.

Use of Wearables: Tracking and Retraining in Endurance Runners

Wearable devices are ubiquitous among runners, coaches, and clinicians with an ever-increasing number of devices coming on the market. In place of gold standard measures in the laboratory, these devices attempt to provide a surrogate means to track running biomechanics outdoors. This review provides an update on recent literature in the field of wearable devices in runners, with an emphasis on criterion validity and usefulness in the coaching and rehabilitation of runners. Our review suggests that while enthusiasm should be tempered, there is still much for runners to gain with wearables. Overall, our review finds evidence supporting the use of wearables to improve running performance, track global training loads applied to the runner, and provide real-time feedback on running speed and run cadence. Case studies illustrate the use of wearables for the purposes of performance and rehabilitation.

Real-time feedback by wearables in running: Current approaches, challenges and suggestions for improvements

Injuries and lack of motivation are common reasons for discontinuation of running. Real-time feedback from wearables can reduce discontinuation by reducing injury risk and improving performance and motivation. There are however several limitations and challenges with current real-time feedback approaches. We discuss these limitations and challenges and provide a framework to optimise real-time feedback for reducing injury risk and improving performance and motivation. We first discuss the reasons why individuals run and propose that feedback targeted to these reasons can improve motivation and compliance. Secondly, we review the association of running technique and running workload with injuries and performance and we elaborate how real-time feedback on running technique and workload can be applied to reduce injury risk and improve performance and motivation. We also review different feedback modalities and motor learning feedback strategies and their application to real-time feedback. Briefly, the most effective feedback modality and frequency differ between variables and individuals, but a combination of modalities and mixture of real-time and delayed feedback is most effective. Moreover, feedback promoting perceived competence, autonomy and an external focus can improve motivation, learning and performance. Although the focus is on wearables, the challenges and practical applications are also relevant for laboratory-based gait retraining.

Humans Optimize Ground Contact Time and Leg Stiffness to Minimize the Metabolic Cost of Running

Trained endurance runners appear to fine-tune running mechanics to minimize metabolic cost. Referred to as self-optimization, the support for this concept has primarily been collated from only a few gait (e.g., stride frequency, length) and physiological (e.g., oxygen consumption, heart rate) characteristics. To extend our understanding, the aim of this study was to examine the effect of manipulating ground contact time on the metabolic cost of running in trained endurance runners. Additionally, the relationships between metabolic cost, and leg stiffness and perceived effort were examined. Ten participants completed 5 × 6-min treadmill running conditions. Self-selected ground contact time and step frequency were determined during habitual running, which was followed by ground contact times being increased or decreased in four subsequent conditions whilst maintaining step frequency (2.67 ± 0.15 Hz). The same self-selected running velocity was used across all conditions for each participant (12.7 ± 1.6 km · h^-1). Oxygen consumption was used to compute the metabolic cost of running and ratings of perceived exertion (RPE) were recorded for each run. Ground contact time and step frequency were used to estimate leg stiffness. Identifiable minimums and a curvilinear relationship between ground contact time and metabolic cost was found for all runners (r ² = 0.84). A similar relationship was observed between leg stiffness and metabolic cost (r ² = 0.83). Most (90%) runners self-selected a ground contact time and leg stiffness that produced metabolic costs within 5% of their mathematical optimal. The majority (n = 6) of self-selected ground contact times were shorter than mathematical optimals, whilst the majority (n = 7) of self-selected leg stiffness' were higher than mathematical optimals. Metabolic cost and RPE were moderately associated (r _s = 0.358 p = 0.011), but controlling for condition (habitual/manipulated) weakened this relationship (r _s = 0.302, p = 0.035). Both ground contact time and leg stiffness appear to be self-optimized characteristics, as trained runners were operating at or close to their mathematical optimal. The majority of runners favored a self-selected gait that may rely on elastic energy storage and release due to shorter ground contact times and higher leg stiffness's than optimal. Using RPE as a surrogate measure of metabolic cost during manipulated running gait is not recommended.

The stiff plate location into the shoe influences the running biomechanics

The changes in running biomechanics induced by an increased longitudinal bending stiffness (stiff plates added into the shoes) have been well investigated, but little is known concerning the effects of the stiff plate location into the shoe on running biomechanics. Fourteen male recreational runners ran at two participant-specific running speeds (3.28 ± 0.28 m/s and 4.01 ± 0.27 m/s) with two shoe conditions where a stiff plate was added either in high (under the insole) or low location (between the midsole and outsole). Ground reaction forces, lower limb joint angles, net joint torques and work, as well as alignment between the resultant ground reaction force and the leg were analysed. Among the running speeds performed by the runners, the high location significantly decreased propulsive ground reaction forces, increased metatarsophalangeal joint dorsiflexion and ankle plantarflexion, induced an increased alignment between the resultant ground reaction force and the runner's leg, thus decreasing all the lower limb joint torques and the positive work at the knee joint compared to the low location. The results suggested that the high stiff plate location into the shoe should be considered for running performance perspectives, but care should be taken to not alter the perceived comfort and/or increase injury risks.

Energy cost of running instability evaluated with wearable trunk accelerometry

Maintaining stability under dynamic conditions is an inherent challenge to bipedal running. This challenge may impose an energetic cost (Ec) thus hampering endurance running performance, yet the underlying mechanisms are not clear. Wireless triaxial trunk accelerometry is a simple tool that could be used to unobtrusively evaluate these mechanisms. Here, we test a cost of instability hypothesis by examining the contribution of trunk accelerometry-based measures (triaxial root mean square, step and stride regularity, and sample entropy) to interindividual variance in Ec (J/m) during treadmill running. Accelerometry and indirect calorimetry data were collected concurrently from 30 recreational runners (16 men; 14 women) running at their highest steady-state running speed (80.65 ± 5.99% V̇o_2max). After reducing dimensionality with factor analysis, the effect of dynamic stability features on Ec was evaluated using hierarchical multiple regression analysis. Three accelerometry-based measures could explain an additional 10.4% of interindividual variance in Ec after controlling for body mass, attributed to anteroposterior stride regularity (5.2%), anteroposterior root mean square ratio (3.2%), and mediolateral sample entropy (2.0%). Our results lend support to a cost of instability hypothesis, with trunk acceleration waveform signals that are 1) more consistent between strides anteroposterioly, 2) larger in amplitude variability anteroposterioly, and 3) more complex mediolaterally and are energetically advantageous to endurance running performance. This study shows that wearable trunk accelerometry is a useful tool for understanding the Ec of running and that running stability is important for economy in recreational runners. NEW & NOTEWORTHY This study evaluates and more directly lends support to a cost of instability hypothesis between runners. Moreover, this hypothesis was tested using a minimalist setup including a single triaxial trunk mounted accelerometer, with potential transferability to biomechanical and performance analyses in typical outdoor settings.

Is There an Economical Running Technique? A Review of Modifiable Biomechanical Factors Affecting Running Economy

Running economy (RE) has a strong relationship with running performance, and modifiable running biomechanics are a determining factor of RE. The purposes of this review were to (1) examine the intrinsic and extrinsic modifiable biomechanical factors affecting RE; (2) assess training-induced changes in RE and running biomechanics; (3) evaluate whether an economical running technique can be recommended and; (4) discuss potential areas for future research. Based on current evidence, the intrinsic factors that appeared beneficial for RE were using a preferred stride length range, which allows for stride length deviations up to 3 % shorter than preferred stride length; lower vertical oscillation; greater leg stiffness; low lower limb moment of inertia; less leg extension at toe-off; larger stride angles; alignment of the ground reaction force and leg axis during propulsion; maintaining arm swing; low thigh antagonist–agonist muscular coactivation; and low activation of lower limb muscles during propulsion. Extrinsic factors associated with a better RE were a firm, compliant shoe–surface interaction and being barefoot or wearing lightweight shoes. Several other modifiable biomechanical factors presented inconsistent relationships with RE. Running biomechanics during ground contact appeared to play an important role, specifically those during propulsion. Therefore, this phase has the strongest direct links with RE. Recurring methodological problems exist within the literature, such as cross-comparisons, assessing variables in isolation, and acute to short-term interventions. Therefore, recommending a general economical running technique should be approached with caution. Future work should focus on interdisciplinary longitudinal investigations combining RE, kinematics, kinetics, and neuromuscular and anatomical aspects, as well as applying a synergistic approach to understanding the role of kinetics.

Effects of two neuromuscular training programs on running biomechanics with load carriage: a study protocol for a randomised controlled trial

Background

In recent years, athletes have ventured into ultra-endurance and adventure racing events, which tests their ability to race, navigate, and survive. These events often require race participants to carry some form of load, to bear equipment for navigation and survival purposes. Previous studies have reported specific alterations in biomechanics when running with load which potentially influence running performance and injury risk. We hypothesize that a biomechanically informed neuromuscular training program would optimize running mechanics during load carriage to a greater extent than a generic strength training program.

Methods

This will be a two group, parallel randomized controlled trial design, with single assessor blinding. Thirty healthy runners will be recruited to participate in a six weeks neuromuscular training program. Participants will be randomized into either a generic training group, or a biomechanically informed training group. Primary outcomes include self-determined running velocity with a 20 % body weight load, jump power, hopping leg stiffness, knee extensor and triceps-surae strength. Secondary outcomes include running kinetics and kinematics. Assessments will occur at baseline and post-training.

Discussion

To our knowledge, no training programs are available that specifically targets a runner’s ability to carry load while running. This will provide sport scientists and coaches with a foundation to base their exercise prescription on.

Trial registration

ANZCTR (ACTRN12616000023459) (14 Jan 2016)

Electronic supplementary material

The online version of this article (doi:10.1186/s12891-016-1271-9) contains supplementary material, which is available to authorized users.

Baseline predictors of treatment gains in peak propulsive force in individuals poststroke

Background

Current rehabilitation for individuals poststroke focuses on increasing walking speed because it is an indicator of community walking ability and quality of life. Propulsive force generated from the paretic limb is critical to walking speed and may reflect actual neural recovery that restores the affected neural systems. A wide variation across individuals in the improvements in paretic propulsive force was observed following an intervention that targeted paretic propulsive force. This study aimed to determine if specific baseline characteristics can be used to predict patients who would respond to the intervention.

Methods

Participants (N = 19) with chronic poststroke hemiparesis walked at their self-selected and maximal walking speeds on a treadmill before and after a 12-week gait training program. Propulsive forces from the paretic limb were analyzed. Pearson correlation coefficient was used to determine the relationships between (1) treatment gains in walking speed and propulsive force following intervention, and (2) treatment gains in propulsive force and baseline propulsive forces.

Results

Treatment gains in self-selected walking speed were correlated to treatment gains in paretic propulsive force following intervention. In addition, changes in paretic propulsive force between self-selected and maximal walking speeds at baseline were strongly correlated to treatment gains in paretic propulsive force.

Conclusions

The capacity to modulate paretic propulsive force, rather than the absolute propulsive force during self-selected or maximal walking speed, predicted treatment gains in propulsive force following the intervention. Findings from this research could help to inform clinicians and researchers to target the appropriate patient population for rehabilitation interventions.

Mechanisms used to increase peak propulsive force following 12-weeks of gait training in individuals poststroke

Current rehabilitation efforts for individuals poststroke focus on increasing walking speed because it is a predictor of community ambulation and participation. Greater propulsive force is required to increase walking speed. Previous studies have identified that trailing limb angle (TLA) and ankle moment are key factors to increases in propulsive force during gait. However, no studies have determined the relative contribution of these two factors to increase propulsive force following intervention. The purpose of this study was to quantify the relative contribution of ankle moment and TLA to increases in propulsive force following 12-weeks of gait training for individuals poststroke. Forty-five participants were assigned to 1 of 3 training groups: training at self-selected speeds (SS), at fastest comfortable speeds (Fast), and Fast with functional electrical stimulation (FastFES). For participants who gained paretic propulsive force following training, a biomechanical-based model previously developed for individuals poststroke was used to calculate the relative contributions of ankle moment and TLA. A two-way, mixed-model design, analysis of covariance adjusted for baseline walking speed was performed to analyze changes in TLA and ankle moment across groups. The model showed that TLA was the major contributor to increases in propulsive force following training. Although the paretic TLA increased from pre-training to post-training, no differences were observed between groups. In contrast, increases in paretic ankle moment were observed only in the FastFES group. Our findings suggested that specific targeting may be needed to increase ankle moment.