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Sports Eng (2016) 19:213–218 DOI 10.1007/s12283-016-0209-7 ORIGINAL ARTICLE The influence of sitting posture on mechanics and metabolic energy requirements during sit-skiing: a case report K. B. Hofmann1 • M. L. Ohlsson2 • M. Höök2 • J. Danvind3,4 • Uwe G. Kersting2,5 Published online: 4 June 2016  International Sports Engineering Association 2016 Abstract Several different sitting postures are used in Paralympic cross-country sit-skiing. The aim of this study was to evaluate the impact of sitting posture on physiological and mechanical variables during steady-state double-poling sit-skiing, as well as to determine how seat design can be improved for athletes without sufficient trunk control. Employing a novel, custom-designed seat, three trunk positions were tested while performing double-poling with submaximal oxygen consumption on an ergometer. Cycle kinematics, pole forces, and oxygen consumption were monitored. The athlete performed best, with longer cycle length and less pronounced metabolic responses, when kneeling with the trunk resting on a frontal support. For this case, a forward leaning trunk with knees below the hip joint was interpreted as most optimal, as it showed lower oxygen consumption and related parameters of performance during cross-country sit-skiing. Further investigations should examine whether such improvement is & Uwe G. Kersting uwek@hst.aau.dk 1 Otto Bock Healthcare Products GmbH, Vienna, Austria 2 Department of Health Sciences, Swedish Winter Sports Research Center, Mid Sweden University, Östersund, Sweden 3 Department of Quality Technology and Management, Mechanical Engineering and Mathematics, Mid Sweden University, Östersund, Sweden 4 Parasport Sweden and Swedish Paralympic Committee, Stockholm, Sweden 5 Department of Health Science and Technology, The Faculty of Medicine, Center for Sensory-Motor Interaction, Aalborg University, Fredrik Bajers Vej 7D3, 9220 Aalborg Ø, Denmark dependent on the level of the athlete’s handicap, as well as whether it is also seen on snow. Keywords Sit-ski  Oxygen consumption  Biomechanics  Poling force  Seat 1 Background After being introduced at the Paralympic Winter Games in Innsbruck 1988, cross-country sit-skiing (XCSS) has become an integral part of cross-country skiing competitions organized by the International Paralympic Committee (IPC). When performing this sport, athletes sit on a seat mounted on a pair of skis and generate forward propulsion employing the double-poling (DP) technique, i.e., using the right and left poles simultaneously. To divide them into classes with similar physical limitations, the Test-Table-Test is utilized to categorize these athletes on the basis of their degree of trunk control and leg impairment into five divisions (LW10, LW10.5, LW11, LW11.5, and LW12) defined by the IPC for Nordic Skiing [1–3]. In connection with optimizing performance, energy transfer between the athlete and his/her equipment is of considerable importance [4, 5]. At submaximal levels of _ 2 ), the relative VO _ 2 is higher oxygen consumption (VO during arm than leg exercise [6] and, therefore, metabolic stress on the arms should be minimized when XCSS. At the Paralympic Winter Games in Vancouver 2010, it was found that competitors in XCSS with sufficient trunk control prefer to place their knees lower than the hip joint, which allows for flexion of the trunk and effective forward propulsion with a large pole angle during poling [7]. 214 To enable this preferred sitting posture also for athletes with insufficient trunk control, a new seat with frontal support was designed here, and the biomechanics (kinetics and kinematics) and metabolic output associated with three different sitting positions were compared. Our hypotheses were that a forward lean of the trunk both requires less metabolic energy and enables lower poling frequency, both longer absolute pushing and return times, than a backward lean. 2 Case description and methods 2.1 Subject One male athlete (body height, 1.50 m; body mass, 66.1 kg; age, 40 years) volunteered for this study who had participated in XCSS competitions in earlier Paralympic Winter Games, and was preparing to compete in sledge hockey in the 2014 Sochi Paralympic Winter Games. With a growth defect in his legs, but adequate sitting stability, the athlete was placed in the LW 12 class [2]. Prior to the testing, he provided written informed consent, which was approved by the Regional Ethical Review Board in Umeå, Sweden (2013/412-31). 2.2 Testing procedures K. B. Hofmann et al. trunk leaning backward onto a back rest with knees in level with hip joints (TB KinLevel ). Testing procedures were performed on 2 days, separated by an 18-h resting period. The subject was instructed to only perform light exercise (45–60 min low intensity) the day before the testing procedures and eat and drink normally. On the first day of testing, the subject was instructed to refrain from food and caffeine ingestion for at least 2 h prior testing on both days. On the second day, the subject was instructed to eat a light meal not later than 1 h before each test. Drinking was limited to water from 1 h before and during all tests as the subject wished. In a separate session prior to the testing, the subject was familiarized with the ergometer to find a preferred sitting posture for the maximum effort trial, to become accustomed to the testing environment and being introduced to the Borg Rating of Perceived Exertion (RPE) 6–20 scale [8]. On test day 1, a 10-min warm-up with DP was performed followed by _ 2 max) in the 5-min maximum oxygen uptake test (VO preferred sitting posture, the TF Kbelow posture, during which he was strongly encouraged and provided with feedback each minute. The criteria for maximum effort were a respiratory exchange ratio (RER) C1.1 and RPE (breathing and arms) C18. On test day 2, the subject per_ 2 max, separated by formed three 7-min trials at 80 % VO 2 h of rest to avoid fatigue [9]. Each trial began with a 10-min warm-up and involved one of the three different sitting postures. Time of preparation and testing took approximately 6 h on the test day 2. All DP trials were carried out on a commercial skiing ergometer (ThoraxTrainer, ThoraxTrainer ApS, Kokkedal, Denmark) equipped with a custom-made adjustable seat. The following trunk positions were tested (Fig. 1): trunk leaning forward onto a support rest with knees below the hip joints (TF Kbelow ), trunk leaning forward onto a support rest with knees above the hip joints (TF Kabove ) and _ 2 similar to that under racing conditions, To maintain a VO the subject was provided with a visual display (Dansprint Aps, Hvidovre, Denmark) of his power output (W). Data Fig. 1 Subject in the three different sitting positions wearing a fullbody set of reflective markers. a Trunk lean forward onto a support with the knees positioned below the hip joint (TF Kbelow ). b Trunk leaning forward onto a support with the knees positioned above the hip joint (TF Kabove ). c Trunk leaning backward, with the knees level with the hip joint (TB KinLevel ) 2.3 Experimental setup The influence of sitting posture on mechanics and metabolic energy requirements during sit… were recorded with the ThoraxTrainer Analyser Software. Strain-gauge force sensors equipped with amplifiers (Biovision, Wehrheim, Germany) were calibrated and used to measure resultant pole forces at a sampling frequency of 250 Hz. The load cells were mounted between the grip and pole, and the signals transmitted wirelessly (TeleMyo 2400T G2) to a receiver (TeleMyo 2400R G2, Noraxon USA Inc., Scottsdale, USA) and synchronised with the kinematic data. Three-dimensional kinematic data were recorded with eight Oqus3? (Qualisys AB, Gothenburg, Sweden) cameras and the QualysisTrackManager software at a sampling frequency of 250 Hz (standard deviation of calibration wand length during calibration was 0.57 mm, as computed by the software). A full-body marker set, including four markers on the poles, was employed. The retroflective markers were placed on the skin and covered with tightfitting perforated Lycra wear. Respiratory variables, ambient conditions (Vaisala PTU200, Vaisala Oy, Helsinki, Finland), and heart rate (RS400, Polar Electro Oy, Kempele, Finland) were continuously monitored during all trials. Respiratory variables were monitored with the mixed expired procedure, employing an ergo-spirometry system (AMIS 2001 model C, Innovision A/S, Odense, Denmark) equipped with pneumotachograph to measure inspiratory flow. This system was calibrated with the standardized procedure described by Björklund et al. [10]. The subject wore a mouthpiece and nose clip during the tests. 2.4 Data analysis Respiratory variables were analysed in Excel (Office Excel 2010, Microsoft Corporation, Redmond, USA). The oxy_ 2 (l/min) was computed as mean gen consumption rate VO of the fifth minute, where steady-state were achieved, at the pre-defined constant power output in the submaximal tests _ 2 was compared between the three different (80 %). VO sitting postures. The Visual3D (v5 professional, C-Motion Inc., Germantown, USA) software was used to process kinematic data from the right side of the body. All signals were smoothed by a low-pass Butterworth filter with a cutoff frequency of 6 Hz. One poling cycle was defined between consecutive occasions of the right pole tip reaching its most anterior position. The poling cycle was divided into a pushing phase and a return phase: the pushing phase started when right pole tip reached the most anterior position and ended in the most posterior position, and the return phase was defined as the opposite. Cycle length was obtained by multiplying cycle time by the speed provided by the ThoraxTrainer Analyser Software. Resultant pole forces were used to calculate peak pole forces and horizontal impulses. 215 The kinematic model was applied to extract elbow, shoulder, knee, and hip joint angles from the marker trajectories. The joint angles () were defined in the elbow (between the upper arm and forearm, fully extended 0), shoulder (flexion (?) and extension (-), hip (between the femur and pelvis, flexion (?) and extension (-), standing 0), knee [flexion (?)] and thorax [forward lean (?)], and pole in the sagittal plane [vertical (0) and forward lean (?)]. Kinetic and kinematic measures were analysed and averaged for ten cycles. Descriptive statistics were employed and results are presented as mean ± standard deviation (SD) taken during the fifth minute of each submaximal trial to ensure that the subject was in a steadystate condition. 3 Findings and outcomes _ 2 max test, the athlete attained a RER of During the VO 1.35 ± 0.03 and RPE of 18, thereby fulfilling the criteria for maximal effort. During all submaximal trials, the subject was able to maintain the designated level of power, performing DP at a constant power output. 3.1 Physiological responses In Table 1, results are shown for power output, cardiorespiratory responses, cycle characteristics, and kinetic parameters during the maximal test and the three 7-min _ 2 max) in three different trunksubmaximal tests (80 % VO stabilising postures. All values are expressed as mean ± SD (n = 10 cycles). _ 2 , minute ventilation (VE) (l/min), and tidal The VO volume (VT) (l/breath) were all higher during TF Kabove than the other conditions, TB KinLevel and TF Kbelow indicating a higher demand in the posture TF Kabove . Breathing frequency and heart rate (HR) were lower during TF Kbelow than TF Kabove and TB KinLevel (Table 1). 3.2 Cycle characteristics The athlete demonstrated the longest cycle length during TF Kbelow , followed by TF Kabove and then TB KinLevel , with the same order for absolute pushing, return, and cycle times (Table 1). Cycle frequency was lowest for TF Kbelow , followed by TF Kabove and TB KinLevel . The locomotor-respiratory coupling (ratio of cycle frequency to respiratory frequency) was 1:1.44, 1:1.42, and 1:1.22 for TF Kbelow , TF Kabove , and TB KinLevel , respectively (Table 1). The shortest relative pushing time was observed 216 Table 1 Power output, cardiorespiratory responses, cycle characteristics, and kinetic parameters of an XCSS athlete during the maximal test and the three 7-min submaximal tests _ 2 max) in three (80 % VO different trunk-stabilising postures K. B. Hofmann et al. _ 2 max VO TF Kbelow TF Kabove TB KinLevel Power (W) 53 ± 19 37 ± 5 37 ± 5 37 ± 6 Speed (m/s) 2.85 ± 0.48 2.38 ± 0.12 2.37 ± 0.09 2.37 ± 0.13 Physiological responses _ 2 (l/min) VO 1.98 ± 0.02 1.61 ± 0.05 1.80 ± 0.15 1.61 ± 0.03 VE (l/min) 128 ± 2.46 50.8 ± 1.79 60.2 ± 5.44 53.0 ± 2.01 VT (l/breath) 2.79 ± 0.03 2.00 ± 0.17 2.15 ± 0.26 1.46 ± 0.13 Breathing frequency (bpm) 45.9 ± 0.42 25.6 ± 2.17 28.2 ± 2.80 36.5 ± 2.86 HR (bpm) 171 ± 1 142 ± 1 152 ± 1 149 ± 1 Cycle characteristics Cycle time (s) 1.62 ± 0.03 1.49 ± 0.03 1.35 ± 0.01 Cycle frequency (cycles/min) 37.0 40.3 44.4 Pushing time (s) 0.80 ± 0.03 0.75 ± 0.02 0.68 ± 0.02 Return time (s) 0.82 ± 0.02 0.74 ± 0.02 0.68 ± 0.02 Cycle length (m) 3.86 ± 0.07 3.53 ± 0.07 3.20 ± 0.02 109 ± 5.76 47.4 ± 3.47 112 ± 3.84 49.4 ± 4.63 100 ± 8.41 37.4 ± 3.07 Kinetic parameters Peak pole force (N) Impulse (Ns) All values are expressed as mean ± SD (n = 10 cycles) TF Kbelow trunk leaning forward with knees below hip joints TF Kabove trunk leaning forward with knees above hip joints TB KinLevel trunk leaning backward with knees level with hip joints of the pushing phase that ended approximately after the first quarter of the return period (Fig. 2). Thereafter, pole forces showed a slight elevation prior to the next pushing phase. The resultant peak pole force and amplitude of the signal during TF Kbelow and TF Kabove were 109 ± 5.76 and 112 ± 3.84, respectively, whereas peak pole force during TB KinLevel was lower, 100 ± 8.41, which was also the case for the impulse outcomes (Table 1). 3.4 Angular movement Fig. 2 Pole force for ten representative cycles by an XCSS athlete performing three 7-min submaximal tests (80 % VO2 maxÞ in three different trunk-stabilising positions (TF Kbelow , TF Kabove , TB KinLevel ). The vertical lines indicate the change from pushing to return phase during TF Kbelow and closely followed by TB KinLevel and TF Kabove (Fig. 2). 3.3 Kinetics For all trials, the time-course of the resultant pole force exhibited a pre-peak plateau, followed by a rapid rise to peak force and then a moderate reduction in the latter half In Table 2, the results of the kinematics of the submaximal _ 2 max) are shown. The values presented are tests (80 % VO mean ± SD (n = 10 cycles). The range of motion (ROM), as well as maximum (Max) and minimum (Min) angles for the elbow and shoulder were similar for TF Kbelow and TF Kabove , whereas TB KinLevel was characterized by lower values for these parameters. During all trials, the Min pole angle occurred at the beginning of the pushing phase and the Max near the start of the return phase. In contrast to TF Kabove and TB KinLevel variables, TF Kbelow was associated with the smallest overall angular displacement of the extracted hip, knee, and thorax (Table 2). However, these displacements were expected to be low in all cases to maintain a stable sitting posture. The influence of sitting posture on mechanics and metabolic energy requirements during sit… Table 2 Angles () at the elbow (between the upper arm and forearm), shoulder [flexion (?) and extension (-), hip (between the femur and pelvis), flexion (?) and extension (-), standing 0], knee [flexion (?)] and thorax [forward lean (?)], and pole in the sagittal plane [vertical (0) and forward lean (?)] for an XCSS athlete during the fifth minute of 7-min submaximal tests (80 % _ 2 max) of double-poling in VO three different sitting postures 217 Angle () Elbow Shoulder Hip Knee Thorax Pole TF Kbelow ROM 59.9 ± 4.6 84.5 ± 2.7 3.4 ± 0.5 1.4 ± 0.3 3.8 ± 0.6 60.2 ± 2.0 Max 81.7 ± 5.3 69.5 ± 1.4 78.8 ± 0.5 158 ± 0.2 10.4 ± 0.4 80.8 ± 0.5 Min 21.8 ± 3.0 -14.9 ± 2.0 75.4 ± 0.4 157 ± 0.2 6.6 ± 0.3 20.6 ± 1.8 TF Kabove ROM 60.9 ± 5.0 85.2 ± 3.0 14.7 ± 3.1 15.0 ± 3.1 4.1 ± 1.0 56.2 ± 2.3 Max 87.2 ± 6.7 71.8 ± 1.6 120 ± 0.7 60.2 ± 1.0 15.3 ± 1.2 81.7 ± 0.6 Min 26.2 ± 2.7 -13.4 ± 2.1 105 ± 2.9 45.2 ± 2.9 11.2 ± 0.4 25.5 ± 2.5 ROM 48.7 ± 2.3 71.1 ± 1.6 9.8 ± 1.6 4.8 ± 0.5 9.1 ± 1.7 58.1 ± 1.1 Max Min 78.3 ± 2.5 29.6 ± 2.9 63.4 ± 1.1 -7.6 ± 2.0 90.4 ± 1.7 80.6 ± 0.7 61.3 ± 0.5 56.5 ± 0.4 0.9 ± 1.9 -8.2 ± 0.9 81.0 ± 0.4 23.0 ± 0.9 TB KinLevel The values presented are mean ± SD (n = 10 cycles) TF Kbelow trunk leaning forward with knees below hip joints TF Kabove trunk leaning forward with knees above hip joints TB KinLevel trunk leaning backward with knees level with hip joints 4 Discussion The purpose of this study was to investigate how sitting posture affects double-poling submaximal workloads for a Paralympic sit-skier. The main finding was that the posture TF Kabove had 12 % higher oxygen consumption rate than TF Kbelow and TB KinLevel at the same power output. In posture TF Kbelow , a longer cycle time and a greater cycle length were observed indicating that this posture might be the optimal out of these three postures for this subject. Only limited knowledge concerning the influence of different XCSS body postures on biomechanical and physiological responses is presently available [11]. Previous studies have considered the potential impact of seating position on the performance of elite athletes during a DP XCSS race [12], and the significance of seating position for efficient movement during sit-skiing has also been pointed out [7]. VT was smallest in TB KinLevel , while breathing frequency was largest and the product of these two resulted in the largest VE. Breathing frequency was coupled to poling frequency, but the locomotor-respiratory ratios were higher than 1:1, as observed during double poling while standing by able-bodied athletes [13]. Even though oxygen consumption rates in this study were similar for the postures TF Kbelow and TB KinLevel (1.61 l/min), we interpret the TF Kbelow as the most optimal posture for our case subject. This interpretation was supported by an integrated biomechanical and physiological perspective, with the TB KinLevel results showing lower elbow and shoulder ROM with higher cycle frequency. Higher cycle frequency was connected to higher breathing frequency, and with higher breathing frequency, smaller VT was observed. The interpretation that the posture TF Kbelow was the most optimal was also supported by the lowest HR being recorded for this position. As demonstrated previously, faster able-bodied skiers exhibit longer absolute pushing and return phases, resulting in an overall longer cycle length [14, 15], and similar observations have been made on sit-skiers [10]. In the present case, to maintain speed with the shorter cycle length and cycle time in TB KinLevel , the athlete increased the cycle frequency, accompanied by higher breathing and smaller elbow and shoulder ROM (Table 2). An increased cycle frequency requires faster muscle contractions which reduce active muscle force generation according to the force–velocity relationship, therefore, leading to less effective poling. It may also be the case that a forward orientation of the trunk allows for a more effective use of the shoulder extensors, as it has been indicated that an increased shoulder flexion results in a larger ROM with an increased extension force [16]. Based on the present results, it cannot be predicted how these two mechanisms interact in different athletes, warranting further research. 5 Limitations As this study is a case study for one individual with a specific training status and level of handicap results can, obviously, not be transferred to any sit-skier. The order of testing might have influenced our results. However, since 218 TB KinLevel , the last position to be tested, resulted in a lower oxygen consumption value than TF Kabove , it is unlikely that the subject was fatigued. Another limitation of this study is the application of the strain-gauge sensors. Pole forces should be interpreted with caution because of the potential proportion of bending stress during the transition between pushing-to-return phase. Moreover, the trials were carried out on an ergometer that did not allow for a minimal pole angle at the beginning of the pushing phase and the ergometer required considerable pulling forces during the return phase, which may alter the technique and timing of joint actions compared to on-snow sit-skiing. Even though the athlete in this study was not reliant on trunk support, the present results demonstrate how sledge seat construction potentially influences the poling performance, which might be of particular importance to athletes lacking sufficient trunk stability. 6 Conclusion With a forward leaning trunk and the knees below the hips while sitting, TF Kbelow , poling mean oxygen consumption rate was similar to leaning backward, TB KinLevel , whereas a forward lean with the knees above the hip, TF Kabove , showed a 12 % higher oxygen consumption rate. The posture TF Kbelow showed longer cycle time, longer pushing length, larger VT, and lower HR and, therefore, this posture was interpreted as the most optimal out of the three for this subject. This also indicates that athletes with insufficient trunk control could likewise benefit from such posture. Future investigations should examine the effects of various hip and knee angles, as well as pole angle at the time of pole plant on cycle characteristics during XCSS. Compliance with ethical standards Conflict of interest The authors have no conflict of interest to declare. K. B. Hofmann et al. References 1. International Paralympic Committee (2007) IPC classification code. http://www.paralympic.org/the-ipc/handbook. Accessed 17 Jan 2014 2. International Paralympic Committee (2013) IPC nordic skiing rules and regulations. http://www.paralympic.org/nordic-skiing/ rules-and-regulations/classification. Accessed 17 Jan 2014 3. 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