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Takeda R, Nojima H, Nishikawa T, Okudaira M, Hirono T, Watanabe K. Can Neuromuscular Electrical Stimulation Enhance the Effect of Sprint Interval Training? Int J Sports Med 2024; 45:672-677. [PMID: 38286427 DOI: 10.1055/a-2256-0285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2024]
Abstract
The aim of this study was to determine the effects of subtetanic neuromuscular electrical stimulation combined with voluntary exercise between repeated Wingate tests on sprint exercise performance and blood lactate accumulation during sprint interval training. Fifteen healthy young males volunteered. After 1-min baseline, participants underwent the Wingate test twice. They performed a 4-min intervention between tests: neuromuscular electrical stimulation with free-weight cycling or voluntary cycling alone [43.6 (8.0) watts], which matched oxygen consumption with neuromuscular electrical stimulation with free-weight cycling. The blood lactate concentration was assessed at the end of the baseline, at 3-min intervention, and on recovery at 1, 3, 5, and 10 min after the second Wingate test. Peak and mean blood lactate concentration during recovery were significantly greater with neuromuscular electrical stimulation with free-weight cycling than voluntary cycling alone (P>0.036 and P=0.011, respectively). Peak power, mean power, and rate of decline (fatigue index) were not significantly different between conditions in both Wingate tests (condition/interaction all P>0.300, partial η2<0.1). Subtetanic neuromuscular electrical stimulation combined with voluntary exercise indicated similar exercise performance and fatigue levels during Wingate tests, but enhanced blood lactate accumulation compared to oxygen consumption-matched voluntary cycling during sprint interval training.
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Affiliation(s)
- Ryosuke Takeda
- Laboratory of Neuromuscular Biomechanics, Chukyo University - Toyota Campus, Toyota, Japan
| | - Hiroya Nojima
- Laboratory of Neuromuscular Biomechanics, Chukyo University - Toyota Campus, Toyota, Japan
| | - Taichi Nishikawa
- Graduate School of Health and Sport Sciences, Chukyo University, Toyota, Japan
| | - Masamichi Okudaira
- Laboratory of Neuromuscular Biomechanics, Chukyo University - Toyota Campus, Toyota, Japan
| | - Tetsuya Hirono
- Laboratory of Neuromuscular Biomechanics, Chukyo University - Toyota Campus, Toyota, Japan
- Health and Sport Sciences, Kyoto University, Kyoto, Japan
| | - Kohei Watanabe
- Laboratory of Neuromuscular Biomechanics, Chukyo University - Toyota Campus, Toyota, Japan
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Ando S, Ishioka Y, Kambayashi S, Kano K, Fujibayashi M, Costello JT, Sudo M. Combined effects of electrical muscle stimulation and cycling exercise on cognitive performance. Front Physiol 2024; 15:1408963. [PMID: 38827991 PMCID: PMC11140777 DOI: 10.3389/fphys.2024.1408963] [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: 03/29/2024] [Accepted: 05/08/2024] [Indexed: 06/05/2024] Open
Abstract
The purpose of this study was to investigate whether a combination of electrical muscle stimulation (EMS) and cycling exercise is beneficial for improving cognitive performance. Eighteen participants (7 females and 11 males) performed a Go/No-Go task before and 2 min after i) cycling exercise (EX), ii) a combination of EMS and cycling (EMS + EX) and iii) a control (rest) intervention in a randomized controlled crossover design. In the EX intervention, the participants cycled an ergometer for 20 min with their heart rate maintained at ∼120 beats·min-1. In the EMS + EX intervention, the participants cycled an ergometer simultaneously with EMS for 20 min, with heart rate maintained at ∼120 beats·min-1. In the Control intervention, the participants remained at rest while seated on the ergometer. Cognitive performance was assessed by reaction time (RT) and accuracy. There was a significant interaction between intervention and time (p = 0.007). RT was reduced in the EX intervention (p = 0.054, matched rank biserial correlation coefficient = 0.520). In the EMS + EX intervention, RT was not altered (p = 0.243, Cohen's d = 0.285) despite no differences in heart rate between the EX and EMS + EX interventions (p = 0.551). RT was increased in the Control intervention (p = 0.038, Cohen's d = -0.529). These results indicate that combining EMS and cycling does not alter cognitive performance despite elevated heart rate, equivalent to a moderate intensity. The present findings suggest that brain activity during EMS with cycling exercise may be insufficient to improve cognitive performance when compared to exercise alone.
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Affiliation(s)
- Soichi Ando
- Graduate School of Informatics and Engineering, The University of Electro-Communications, Chofu, Tokyo, Japan
| | - Yuka Ishioka
- Faculty of Informatics and Engineering, The University of Electro-Communications, Chofu, Tokyo, Japan
| | - Sari Kambayashi
- Graduate School of Informatics and Engineering, The University of Electro-Communications, Chofu, Tokyo, Japan
| | - Kosuke Kano
- Graduate School of Informatics and Engineering, The University of Electro-Communications, Chofu, Tokyo, Japan
| | | | - Joseph T. Costello
- School of Sport, Health and Exercise Science, University of Portsmouth, Portsmouth, United Kingdom
| | - Mizuki Sudo
- Physical Fitness Research Institute, Meiji Yasuda Life Foundation of Health and Welfare, Shinjuku, Tokyo, Japan
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Takeda R, Nojima H, Nishikawa T, Okudaira M, Hirono T, Watanabe K. Subtetanic neuromuscular electrical stimulation can maintain Wingate test performance but augment blood lactate accumulation. Eur J Appl Physiol 2024; 124:433-444. [PMID: 37535142 DOI: 10.1007/s00421-023-05291-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 07/24/2023] [Indexed: 08/04/2023]
Abstract
PURPOSE Concentration- and time-dependent effect of lactate on physiological adaptation (i.e., glycolytic adaptation and mitochondrial biogenesis) have been reported. Subtetanic neuromuscular electrical stimulation (NMES) with voluntary exercise (VOLES) can increase blood lactate accumulation. However, whether this is also true that VOLES can enhance the blood lactate accumulation during sprint exercise is unknown. Thus, we investigated whether VOLES before the Wingate test can enhance blood lactate accumulation without compromising Wingate exercise performance. METHODS Fifteen healthy young males (mean [SD], age: 23 [4] years, body mass index: 22.0 [2.1] kg/m2) volunteered. After resting measurement, participants performed a 3-min intervention: VOLES (NMES with free-weight cycling) or voluntary cycling alone, which matched exercise intensity with VOLES (VOL, 43.6 [8.0] watt). Then, they performed the Wingate test with 30 min free-weight cycling recovery. The blood lactate concentration ([La]b) was assessed at the end of resting and intervention, and recovery at 1, 3, 5, 10, 20, and 30 min. RESULTS [La]b during intervention was higher with VOLES than VOL (P = 0.011). The increase in [La]b after the Wingate test was maintained for longer with VOLES than VOL at 10- and 20-min recovery (P = 0.014 and 0.023, respectively). Based on the Wingate test, peak power, mean power, and the rate of decline were not significantly different between VOLES and VOL (P = 0.184, 0.201, and 0.483, respectively). CONCLUSION The combination of subtetanic NMES with voluntary exercise before the Wingate test has the potential to enhance blood lactate accumulation. Importantly, this combined approach does not compromise Wingate exercise performance compared to voluntary exercise alone.
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Affiliation(s)
- Ryosuke Takeda
- Laboratory of Neuromuscular Biomechanics, School of Health and Sport Science, Chukyo University, 101 Tokodachi, Kaizu-cho, Toyota, Aichi, 470-0393, Japan.
| | - Hiroya Nojima
- Laboratory of Neuromuscular Biomechanics, School of Health and Sport Science, Chukyo University, 101 Tokodachi, Kaizu-cho, Toyota, Aichi, 470-0393, Japan
| | - Taichi Nishikawa
- Laboratory of Neuromuscular Biomechanics, School of Health and Sport Science, Chukyo University, 101 Tokodachi, Kaizu-cho, Toyota, Aichi, 470-0393, Japan
- Graduate School of Health and Sport Sciences, Chukyo University, Toyota, Japan
| | - Masamichi Okudaira
- Laboratory of Neuromuscular Biomechanics, School of Health and Sport Science, Chukyo University, 101 Tokodachi, Kaizu-cho, Toyota, Aichi, 470-0393, Japan
| | - Tetsuya Hirono
- Laboratory of Neuromuscular Biomechanics, School of Health and Sport Science, Chukyo University, 101 Tokodachi, Kaizu-cho, Toyota, Aichi, 470-0393, Japan
- Research Fellow of Japan Society for the Promotion of Science, Tokyo, Japan
| | - Kohei Watanabe
- Laboratory of Neuromuscular Biomechanics, School of Health and Sport Science, Chukyo University, 101 Tokodachi, Kaizu-cho, Toyota, Aichi, 470-0393, Japan
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Takeda R, Nojima H, Hirono T, Okudaira M, Nishikawa T, Watanabe K. Impact of subtetanic neuromuscular electrical stimulation on cardiac autonomic nervous system in young individuals. J Sports Med Phys Fitness 2024; 64:78-87. [PMID: 37902806 DOI: 10.23736/s0022-4707.23.15352-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2023]
Abstract
BACKGROUND Although subtetanic neuromuscular electrical stimulation (NMES) has been proposed as an exercise training and/or rehabilitation tool, the impact of NMES on the autonomic nervous system (ANS) is unclear. Thus, we hypothesized that NMES would alter ANS, i.e., increase sympathetic activity and decrease parasympathetic activity, in young individuals. METHODS Eighteen healthy young individuals (16 males, mean age: 22 [SD: 4] years, Body Mass Index: 21.7 [2.2] kg/m2) volunteered. Blood pressure (BP), heart rate (HR), and R-R intervals were recorded during 6-minute resting, NMES, and recovery conditions. Short-term heart rate variability analysis of R-R intervals was performed for the frequency and time domains during each condition. Time domain indices included the root mean square of successive R-R interval differences (RMSSD), and the percentage of successive R-R intervals differing by more than 50ms (pRR50%). Frequency domain indices (fast Fourier transform) of R-R intervals included total power (TP), low-frequency (LF) power (0.04-0.15 Hz), and high-frequency (HF) power (0.15-0.4 Hz). RESULTS BP was not altered but HR was significantly increased during NMES (P<0.001), and it returned to the resting level at recovery. RMSSD and pRR50 decreased from resting to NMES and returned at recovery conditions (P<0.05, respectively). TP and HF decreased from resting to NMES and returned at recovery conditions (P<0.05, respectively). LF increased from NMES to recovery (P<0.05). The LF/HF ratio showed no significant differences between conditions (P=0.210). CONCLUSIONS Cardiac ANS fluctuated by subtetanic NMES without BP elevation in healthy young individuals. Parasympathetic but not sympathetic activity was affected by NMES stimulation.
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Affiliation(s)
- Ryosuke Takeda
- School of Health and Sport Science, Laboratory of Neuromuscular Biomechanics, Chukyo University, Toyota, Japan -
| | - Hiroya Nojima
- School of Health and Sport Science, Laboratory of Neuromuscular Biomechanics, Chukyo University, Toyota, Japan
| | - Tetsuya Hirono
- School of Health and Sport Science, Laboratory of Neuromuscular Biomechanics, Chukyo University, Toyota, Japan
- Japan Society for the Promotion of Science, Tokyo, Japan
| | - Masamichi Okudaira
- School of Health and Sport Science, Laboratory of Neuromuscular Biomechanics, Chukyo University, Toyota, Japan
| | - Taichi Nishikawa
- School of Health and Sport Science, Laboratory of Neuromuscular Biomechanics, Chukyo University, Toyota, Japan
- Graduate School of Health and Sport Sciences, Chukyo University, Toyota, Japan
| | - Kohei Watanabe
- School of Health and Sport Science, Laboratory of Neuromuscular Biomechanics, Chukyo University, Toyota, Japan
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Krause A, da Mota de Moreira I, Walser N, Memmert D, Ritzmann R. Whole-Body Electromyostimulation Impacts Physiological Responses During Aerobic Running: A Randomized Trial. RESEARCH QUARTERLY FOR EXERCISE AND SPORT 2023; 94:1133-1140. [PMID: 36624960 DOI: 10.1080/02701367.2022.2120949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 08/30/2022] [Indexed: 06/17/2023]
Abstract
Objective: The aim of the current study was to evaluate the physiological and metabolic responses to running with whole-body electromyostimulation (wbEMS) compared to running without electromyostimulation (control, CG). Methods: Twenty healthy participants (9 male/11 female, age 42 ±7 years) conducted an incremental step test with respiratory gas analysis until exhaustion. Trials were conducted as wbEMS and CG in a random order. As outcome measures, (A) objective total exhaustion, (B) athletic responses (max. time and velocity) and (C) physiological and metabolic responses (V'O2/ kg, V'E, EE, RER, lactate) were compared. (D) The impact on the skeletal muscle was assessed prior, 48 h & 72 h after trial. Results: During both trials, participants (A) ran until total exhaustion. Nonetheless, (B) time and velocity till exhaustion as well as (C) RER prior to the first lactate threshold and V'E were reduced with wbEMS. All other correlates did not differ significantly between wbEMS and CG. Following 48 h and 72 h after the trial with wbEMS, (D) the impact on the skeletal muscle was 7- to 9-fold higher compared to baseline values. Values differed significantly to those after running without wbEMS. Conclusion: With the additional stimulation during voluntary activation, wbEMS induces earlier fatigue and a shift in energy metabolism toward fat utilization. Even during aerobic endurance tasks, a great impact on the skeletal muscle indicated by the rise in CK could be observed which promotes wbEMS as an alternative training stimulus that is easy-to-apply and effective during endurance training.
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Krause A, Walser N, Centner C, Memmert D, da Mota de Moreia I, Ritzmann R. Running with whole-body electromyostimulation improves physiological determinants of endurance performance - a randomized control trial. BMC Sports Sci Med Rehabil 2023; 15:126. [PMID: 37794506 PMCID: PMC10548652 DOI: 10.1186/s13102-023-00739-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 09/20/2023] [Indexed: 10/06/2023]
Abstract
BACKGROUND This study aimed to evaluate the physiological and metabolic adaptations to an eight-week running intervention with whole-body electromyostimulation (wbEMS) compared to running without wbEMS. METHODS In a randomized controlled trial (RCT), 59 healthy participants (32 female/ 27 male, 41 ± 7 years, rel.V̇O2max 40.2 ± 7.4 ml/min/kg) ran twice weekly à 20 min for eight weeks either with a wbEMS suit (EG) or without wbEMS (control group, CG). Before and after the intervention, (i) rel.V̇O2max, heart rate and time to exhaustion were recorded with an incremental step test with an incremental rate of 1.20 km/h every 3 min. They were interpreted at aerobic and (indirect) anaerobic lactate thresholds as well as at maximum performance. (ii) Resting metabolic rate (RQ) as well as (iii) body composition (%fat) were assessed. RESULTS Following the intervention, V̇O2max was significantly enhanced for both groups (EG ∆13 ± 3%, CG ∆9 ± 3%). Velocity was elevated at lactate thresholds and maximum running speed (EG ∆3 ± 1%, CG ∆2 ± 1%); HRmax was slightly reduced by -1 beat/min. No significant changes were observed for time until exhaustion and lactate. RQ was significantly enhanced following both trainings by + 7%. %fat was reduced for both groups (EG ∆-11 ± 3%, CG ∆-16 ± 5%), without any changes in body mass. Results did not differ significantly between groups. CONCLUSIONS Both interventions had a positive impact on aerobic power. The rightward shift of the time-velocity graph points towards improved endurance performance. The effects of wbEMS are comparable to those after high-intensity training and might offer a time-efficient alternative to affect physiological and metabolic effects. TRIAL REGISTRATION German Clinical Trials Register, ID DRKS00026827, date 10/26/21.
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Affiliation(s)
- Anne Krause
- Institute of Training and Computer Science, German Sport University Cologne, Cologne, Germany
| | | | - Christoph Centner
- Praxisklinik Rennbahn, Muttenz, Switzerland
- Institute of Sport and Science, University of Freiburg, Freiburg, Germany
| | - Daniel Memmert
- Institute of Training and Computer Science, German Sport University Cologne, Cologne, Germany
| | - Ivo da Mota de Moreia
- Institute of Training and Computer Science, German Sport University Cologne, Cologne, Germany
| | - Ramona Ritzmann
- Institute of Sport and Science, University of Freiburg, Freiburg, Germany.
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Zhang J, Xiao X, Jin Q, Li J, Zhong D, Li Y, Qin Y, Zhang H, Liu X, Xue C, Zheng Z, Jin R. The effect and safety of constraint-induced movement therapy for post-stroke motor dysfunction: a meta-analysis and trial sequential analysis. Front Neurol 2023; 14:1137320. [PMID: 37144004 PMCID: PMC10151521 DOI: 10.3389/fneur.2023.1137320] [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: 01/04/2023] [Accepted: 03/13/2023] [Indexed: 05/06/2023] Open
Abstract
Background Due to motor function insufficiency, patients with post-stroke motor dysfunction (PSMD) have limitations in performing an activity, feel restricted during social participation, and feel impaired in their quality of life. Constraint-induced movement therapy (CIMT) is a neurorehabilitation technique, but its effectiveness on PSMD after stroke still remains controversial. Objective This meta-analysis and trial sequential analysis (TSA) aimed to comprehensively evaluate the effect and safety of CIMT for PSMD. Methods Four electronic databases were searched from their inception to 1 January 2023 to identify randomized controlled trials (RCTs) investigating the effectiveness of CIMT for PSMD. Two reviewers independently extracted the data and assessed the risk of bias and reporting quality. The primary outcome was a motor activity log for the amount of use (MAL-AOU) and the quality of movement (MAL-QOM). RevMan 5.4, Statistical Package for Social Sciences (SPSS) 25.0, and STATA 13.0 software were used for statistical analysis. The certainty of the evidence was appraised using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) system. We also performed the TSA to assess the reliability of the evidence. Results A total of 44 eligible RCTs were included. Our results showed that CIMT combined with conventional rehabilitation (CR) was superior to CR in improving MAL-AOU and MAL-QOM scores. The results of TSA indicated that the above evidence was reliable. Subgroup analysis demonstrated that CIMT (≥6 h per day or duration ≤ 20 days) combined with CR was more effective than CR. Meanwhile, both CIMT and modified CIMT (mCIMT) combined with CR were more efficient than CR at all stages of stroke. No severe CIMT-related adverse events occurred. Conclusion CIMT may be an optional and safe rehabilitation therapy to improve PSMD. However, due to limited studies, the optimal protocol of CIMT for PSMD was undetermined, and more RCTs are required for further exploration. Clinical trial registration https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=143490, identifier: CRD42019143490.
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Affiliation(s)
- Jiaming Zhang
- School of Health Preservation and Rehabilitation, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Xianjun Xiao
- School of Health Preservation and Rehabilitation, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Qizu Jin
- The Third Hospital of Mianyang, Sichuan Mental Health Center, Mianyang, Sichuan, China
| | - Juan Li
- School of Health Preservation and Rehabilitation, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Dongling Zhong
- School of Health Preservation and Rehabilitation, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Yuxi Li
- School of Health Preservation and Rehabilitation, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Yan Qin
- The Third Hospital of Mianyang, Sichuan Mental Health Center, Mianyang, Sichuan, China
| | - Hong Zhang
- The Third Hospital of Mianyang, Sichuan Mental Health Center, Mianyang, Sichuan, China
| | - Xiaobo Liu
- School of Health Preservation and Rehabilitation, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Chen Xue
- School of Health Preservation and Rehabilitation, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Zhong Zheng
- Center for Neurobiological Detection, West China Hospital of Sichuan University, Chengdu, Sichuan, China
- *Correspondence: Zhong Zheng
| | - Rongjiang Jin
- School of Health Preservation and Rehabilitation, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
- Rongjiang Jin
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Sawada T, Okawara H, Nakashima D, Ikeda K, Nagahara J, Fujitsuka H, Hoshino S, Maeda Y, Katsumata Y, Nakamura M, Nagura T. Constant Load Pedaling Exercise Combined with Electrical Muscle Stimulation Leads to an Early Increase in Sweat Lactate Levels. SENSORS (BASEL, SWITZERLAND) 2022; 22:9585. [PMID: 36559954 PMCID: PMC9784187 DOI: 10.3390/s22249585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 12/06/2022] [Accepted: 12/06/2022] [Indexed: 06/17/2023]
Abstract
A novel exercise modality combined with electrical muscle stimulation (EMS) has been reported to increase cardiovascular and metabolic responses, such as blood lactate concentration. We aimed to examine the effect of constant load pedaling exercise, combined with EMS, by non-invasively and continuously measuring sweat lactate levels. A total of 22 healthy young men (20.7 ± 0.8 years) performed a constant load pedaling exercise for 20 min at 125% of the pre-measured ventilatory work threshold with (EMS condition) and without (control condition) EMS stimulation. Blood lactate concentration was measured by blood samples obtained from the earlobe every minute. Sweat lactate was monitored in real time using a sensor placed on the forearm. The sweat lactate threshold (sLT) was defined as the point of increase in sweat lactate. sLT occurred significantly earlier in the EMS condition than in the control condition. In the single regression analysis, the difference in sLT between the two conditions, as the independent variable, was a significant predictor of the difference in blood lactate concentrations at the end of the exercise (p < 0.05, r = −0.52). Sweat lactate measurement may be a noninvasive and simple alternative to blood lactate measurement to determine the effectiveness of exercise combined with EMS.
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Affiliation(s)
- Tomonori Sawada
- Department of Orthopaedic Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan
| | - Hiroki Okawara
- Department of Orthopaedic Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan
| | - Daisuke Nakashima
- Department of Orthopaedic Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan
| | - Kaito Ikeda
- Department of Orthopaedic Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan
| | - Joji Nagahara
- Department of Orthopaedic Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan
| | - Haruki Fujitsuka
- Department of Orthopaedic Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan
| | - Sosuke Hoshino
- Department of Orthopaedic Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan
| | - Yuta Maeda
- Department of Orthopaedic Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan
| | - Yoshinori Katsumata
- Institute for Integrated Sports Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan
- Department of Cardiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan
| | - Masaya Nakamura
- Department of Orthopaedic Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan
| | - Takeo Nagura
- Department of Orthopaedic Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan
- Department of Clinical Biomechanics, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan
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