• Sydney AlterG Anti Gravity Treadmills

    Sydney AlterG Anti-Gravity Treadmills

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Published Clinical Studies

The AlterG anti-gravity treadmill has been the subject of multiple clinical studies by independent researchers worldwide. Here is a comprehensive list of research papers that involve the use of anti-gravity lower body positive pressure treadmill technology.

  • Henkelmann R, Schneider S, Müller D, Gahr R, Josten C, Böhme J. Outcome of patients after lower limb fracture with partial weight bearing postoperatively treated with or without anti-gravity treadmill (alter G®) during six weeks of rehabilitation - a protocol of a prospective randomized trial. BMC Musculoskelet Disord. 2017 Mar 14;18(1):104. doi: 10.1186/s12891-017-1461-0.

    SUMMARY

    BACKGROUND:
    Partial or complete immobilization leads to different adjustment processes like higher risk of muscle atrophy or a decrease of general performance. The present study is designed to prove efficacy of the anti-gravity treadmill (alter G®) compared to a standard rehabilitation protocol in patients with tibial plateau (group 1)or ankle fractures (group 2) with six weeks of partial weight bearing of 20 kg.
    METHODS AND DESIGN:
    This prospective randomized study will include a total of 60 patients for each group according to predefined inclusion and exclusion criteria. 1:1 randomization will be performed centrally via fax supported by the Clinical Trial Centre Leipzig (ZKS Leipzig). Patients in the treatment arm will be treated with an anti-gravity treadmill (alter G®) instead of physiotherapy. The protocol is designed parallel to standard physiotherapy with a frequency of two to three times of training with the treadmill per week with duration of 20 min for six weeks.
    DISCUSSION:
    Up to date no published randomized controlled trial with an anti-gravity treadmill is available. The findings of this study can help to modify rehabilitation of patients with partial weight bearing due to their injury or postoperative protocol. It will deliver interesting results if an anti-gravity treadmill is useful in rehabilitation in those patients. Further ongoing studies will identify different indications for an anti-gravity treadmill. Thus, in connection with those studies, a more valid statement regarding safety and efficacy is possible.

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    Neurology,2016
  • Birgani PM, Ashtiyani M, Rasooli A, Shahrokhnia M, Shahrokhi A, Mirbagheri MM. Can an anti-gravity treadmill improve stability of children with cerebral palsy? Conf Proc IEEE Eng Med Biol Soc. 2016 Aug;2016:5465-5468. doi: 10.1109/EMBC.2016.7591963.

    SUMMARY

    We aimed to study the effects of an anti-gravity treadmill (AlterG) training on balance and postural stability in children with cerebral palsy (CP). AlterG training was performed 3 days/week for 8 weeks, with up to 45 minutes of training per session. The subject was evaluated before and after the 8-week training. The effects of training on the balance and postural stability was evaluated based on the Romberg test that was performed by using a posturography device. The parameters quantifying Center-of-Pressure (CoP) were calculated using different analytical approaches including power spectral density and principal components analyses. All of the key parameters including the Stabilogram, the Fast Fourier Transform (FFT) Energy, the Eigenvectors, and the Eigenvalues of CoP were modified between 14%-84%. The results indicated that the balance features were improved substantially after training. The clinical implication is that the AlterG has the potential to effectively improve postural stability in children with cerebral palsy.

    Neurology,2016
  • Fairman CM, Kendall KL, ,Harris BS, Crandall KJ, McMillan J. Utilization of an Anti-Gravity Treadmill in a Physical Activity Program with Female Breast Cancer Survivors: A Pilot Study. Int J Exerc Sci. 2016; 9(1): 101–109.

    SUMMARY
    Breast Cancer survivors can experience a myriad of physical and psychological benefits as a result of regular exercise. This study aimed to build on previous research using lower impact exercise programs by using an antigravity (Alter-G®) treadmill to administer cardiovascular training. The purpose of this study was to determine the effectiveness a physical activity program, including an Alter-G® treadmill, for improving physiological and psychosocial measures in female breast cancer survivors. A 14-week intervention using an AB-AB study design was employed. Six female breast cancer survivors were recruited to participate in the study. Participants attended three 60-minute sessions per week, consisting of a combination of muscular strength/endurance, and cardiovascular endurance exercises. Consistent with current literature and guidelines, exercise interventions were individualized and tailored to suit individuals. Data was collected and analyzed in 2013. Visual inspection of results found improvements in cardiovascular endurance and measures of body composition. Quality of life was maintained and in some cases, improved. Finally, no adverse effects were reported from the participants, and adherence to the program for those who completed the study was 97%. The results of this study suggest that the use of a physical activity program in combination with an Alter-G® treadmill may provide practical and meaningful improvements in measures of cardiovascular endurance and body composition.

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    Oncology / Cancer,2016
  • Bugbee WD, Pulido PA, Goldberg T, D'Lima DD. Use of an Anti-Gravity Treadmill for Early Postoperative Rehabilitation After Total Knee Replacement: A Pilot Study to Determine Safety and Feasibility. Am J Orthop (Belle Mead NJ). 2016 May-Jun;45(4):E167-73.

    SUMMARY
    The objective was to determine the safety, feasibility, and effects of anti-gravity gait training on functional outcomes (Knee Injury and Osteoarthritis Outcome Score [KOOS], the Timed Up and Go test [TUG], Numerical Rating Scale [NRS] for pain) with the AlterG® Anti-Gravity Treadmill® device for total knee arthroplasty (TKA) rehabilitation. Subjects (N = 30) were randomized to land-based vs anti-gravity gait training over 4 weeks of physical therapy after TKA. Adverse events, complications, and therapist satisfaction were recorded. All patients completed rehabilitation protocols without adverse events. KOOS, TUG, and NRS scores improved in both groups with no significant differences between groups. For the AlterG group, Sports/Recreation and Quality of Life subscales of the KOOS had the most improvement. At the end of physical therapy, TUG and NRS pain scores improved from 14 seconds to 8 seconds and from 2.8 to 1.1, respectively. Subjectively, therapists reported 100% satisfaction with the AlterG. This initial pilot study demonstrated that the AlterG Anti-Gravity Treadmill device was safe and feasible. While functional outcomes improved over time with use of the anti-gravity gait training, further studies are needed to define the role of this device as an alternative or adjunct to established rehabilitation protocols.

    Orthopaedics & Sports Medicine,2016
  • Bugbee WD, Pulido PA, Goldberg T, D'Lima DD. Use of an Anti-Gravity Treadmill for Early Postoperative Rehabilitation After Total Knee Replacement: A Pilot Study to Determine Safety and Feasibility. Am J Orthop (Belle Mead NJ). 2016 May-Jun;45(4):E167-73.

    SUMMARY
    The objective was to determine the safety, feasibility, and effects of anti-gravity gait training on functional outcomes (Knee Injury and Osteoarthritis Outcome Score [KOOS], the Timed Up and Go test [TUG], Numerical Rating Scale [NRS] for pain) with the AlterG® Anti-Gravity Treadmill® device for total knee arthroplasty (TKA) rehabilitation. Subjects (N = 30) were randomized to land-based vs anti-gravity gait training over 4 weeks of physical therapy after TKA. Adverse events, complications, and therapist satisfaction were recorded. All patients completed rehabilitation protocols without adverse events. KOOS, TUG, and NRS scores improved in both groups with no significant differences between groups. For the AlterG group, Sports/Recreation and Quality of Life subscales of the KOOS had the most improvement. At the end of physical therapy, TUG and NRS pain scores improved from 14 seconds to 8 seconds and from 2.8 to 1.1, respectively. Subjectively, therapists reported 100% satisfaction with the AlterG. This initial pilot study demonstrated that the AlterG Anti-Gravity Treadmill device was safe and feasible. While functional outcomes improved over time with use of the anti-gravity gait training, further studies are needed to define the role of this device as an alternative or adjunct to established rehabilitation protocols.

    Orthopaedics & Sports Medicine,2016
  • Rasooli AH, Birgani PM, Azizi S, Shahrokhi A, Mirbagheri MM. Therapeutic effects of an anti-gravity locomotor training (AlterG) on postural balance and cerebellum structure in children with Cerebral Palsy. IEEE Int Conf Rehabil Robot. 2017 Jul;2017:101-105. doi: 10.1109/ICORR.2017.8009229.

    SUMMARY
    We evaluated the therapeutic effects of anti-gravity locomotor treadmill (AlterG) training on postural stability in children with Cerebral Palsy (CP) and spasticity, particularly in the lower extremity. AlterG can facilitate walking by reducing the weight of CP children by up to 80%; it can also help subjects maintain an appropriate posture during the locomotor AlterG training. Thus, we hypothesized that AlterG training, for a sufficient period of time, has a potential to produce cerebellum neuroplasticity, and consequently result in an effective permanent postural stability. AlterG training was given for 45 minutes, three times a week for two months. Postural balance was evaluated using posturography. The parameters of the Romberg based posturography were extracted to quantify the Center of Balance (CoP). The neuroplasticity of Cerebellum was evaluated using a Diffusion Tensor Imaging (DTI). The evaluations were done pre- and post-training. The Fractional Anisotropy (FA) feature was used for quantifying structural changes in the cerebellum. The results showed that AlterG training resulted in an increase in average FA value of the cerebellum white matter following the training. The results of the posturography evaluations showed a consistent improvement in postural stability. These results were consistent in all subjects. Our findings indicated that the improvement in the posture was accompanied with the enhancement of the cerebellum white matter structure. The clinical implication is that AlterG training can be considered a therapeutic tool for an effective and permanent improvement of postural stability in CP children.

    Neurology,2017
  • Parvin S, Taghiloo A, Irani A, Mirbagheri MM. Therapeutic effects of anti-gravity treadmill (AlterG) training on reflex hyper-excitability, corticospinal tract activities, and muscle stiffness in children with cerebral palsy. IEEE Int Conf Rehabil Robot. 2017 Jul;2017:485-490. doi: 10.1109/ICORR.2017.8009295.

    SUMMARY
    We aimed to study therapeutic effects of antigravity treadmill (AlterG) training on reflex hyper-excitability, muscle stiffness, and corticospinal tract (CST) function in children with spastic hemiplegic cerebral palsy (CP). Three children received AlterG training 3 days per week for 8 weeks as experimental group. Each session lasted 45 minutes. One child as control group received typical occupational therapy for the same amount of time. We evaluated hyper-excitability of lower limb muscles by H-reflex response. We quantified muscle stiffness by sonoelastography images of the affected muscles. We quantified CST activity by transcranial magnetic stimulation (TMS). We performed the evaluations before and after training for both groups. H response latency and maximum M-wave amplitude were improved in experimental group after training compared to control group. Two children of experimental group had TMS response. Major parameters of TMS (i.e. peak-to-peak amplitude of motor evoked potential (MEP), latency of MEP, cortical silent period, and intensity of pulse) improved for both of them. Three parameters of texture analysis of sonoelastography images were improved for experimental group (i.e. contrast, entropy, and shear wave velocity). These findings indicate that AlterG training can improve reflexes, muscle stiffness, and CST activity in children with spastic hemiplegic CP and can be considered as a therapeutic tool to improve neuromuscular abnormalities occurring secondary to CP.

    Neurology,2017
  • Azizi S, Marzbani H, Raminfard S, Birgani PM, Rasooli AH, Mirbagheri MM. The impact of an anti-gravity treadmill (AlterG) training on walking capacity and corticospinal tract structure in children with cerebral palsy. Conf Proc IEEE Eng Med Biol Soc. 2017 Jul;2017:1150-1153. doi: 10.1109/EMBC.2017.8037033.

    SUMMARY
    We studied the effects of an anti-gravity treadmill (AlterG) training on walking capacity and corticospinal tract structure in children with Cerebral Palsy (CP). AlterG can help CP children walk on the treadmill by reducing their weights up to 80% and maintain their balance during locomotion. AlterG training thus has the potential to improve walking capacity permanently as it can provide systematic and intense locomotor training for sufficiently long period of time and produce brain neuroplasticity. AlterG training was given for 45 minutes, three times a week for two months. The neuroplasticity of corticospinal tract was evaluated using Diffusion Tensor Imaging (DTI). The fractional Anisotropy (FA) feature was extracted to quantify structural changes of the corticospinal tract. Walking capacity was evaluated using popular clinical measurements of gait; i.e., walking speed, mobility and balance. The evaluations were done before and after training. Our results revealed that AlterG training resulted in an increase in average FA value of the corticospinal tract following the training. The outcome measures of clinical assessments of gait presented enhanced walking capacity of the CP subjects. Our findings indicated that the improved walking capacity was concurrent with the enhancement of the corticospinal tract structure. The clinical implication is that AlterG training may be considered as a therapeutic tool for permanent gait improvement in CP children.

    Neurology,2017
  • Lotfian M, Kharazi MR, Mirbagheri A, Dadashi F, Nourian R, Mirbagheri MM. Therapeutic effects of an anti-gravity treadmill (AlterG) training on gait and lower limbs kinematics and kinetics in children with cerebral palsy. IEEE Int Conf Rehabil Robot. 2017 Jul;2017:170-174. doi: 10.1109/ICORR.2017.8009241.

    SUMMARY
    We aimed to investigate the effects of the lower body weight support treadmill (AlterG) training on kinetics and kinematics of the lower extremities in children with cerebral palsy (CP). We provided a 45-minute training program, 3 times a week for 8 weeks. AlterG can support the subject's weight up to 70% so that the subject will be able to walk more comfortably to reach a more correct walking pattern. The kinematics and kinetics were evaluated using an isokinetic dynamometer. The locomotion parameters were assessed in the gait laboratory. Subjects performance was evaluated at four time points: baseline (prior to training), 1 and 2 months after the beginning of training, and one month after the end of the training (as a follow-up evaluation). The results showed that the major gait, kinematic, and kinetic parameters improved after the AlterG training and were persistent. These findings suggest that the AlterG training can be considered as a therapeutic tool for improving the lower limb performance and locomotion in children with CP.

    Neurology,2017
  • Thomson A, Einarsson E, Witvrouw E, Whiteley R. Running speed increases plantar load more than per cent body weight on an AlterG® treadmill. J Sports Sci. 2017 Feb;35(3):277-282.

    SUMMARY
    The aim of this study was to quantify plantar loads borne by the athlete during rehabilitation. Twenty trained male participants ran on the AlterG® treadmill in 36 conditions: all combinations of indicated BW (50-100%) paired with different walking and running speeds (range 6-16 km · hr-1) in a random order. In-shoe maximum plantar force (Fmax) was recorded. A table is presented with each of the 36 combinations of BW and running speed to allow a more objective progression of plantar loading during rehabilitation. Increasing running speed rather than increasing indicated per cent BW was shown to have the strongest effect on the magnitude of Fmax across the ranges of speeds and indicated per cent BWs examined.

    Physiology & Exercise Science,2014
  • Afzal A, Fung D, Galligan S, Godwin E, Kral J, Salciccioli L, et al. The effect of lower body weight support on arterial wave reflection in healthy adults. J Am Soc Hypertens. 2014 Jun;8(6):388-93.

    SUMMARY
    This study focussed on the short-term effects of body weight support on wave reflection indices using applanation tonometry during progressive body weight support of 25%, 50%, and 75% of body weight in 25 healthy men. In normal men, body weight support acutely decreases the pulse pressure amplification ratio, increases the amplitude and duration of the reflected aortic pressure wave, and increases measures of wasted left ventricular pressure energy and oxygen demand.

    Physiology & Exercise Science,2014
  • Buono M, Burnsed-Torres M, Hess B, Lopez K, Ortiz C, Girodo A, et al. Alterations in the rate of limb movement using a lower body positive pressure treadmill do not influence respiratory rate or phase III ventilation. Biomed Res Int. 2015;2015:618291

    SUMMARY
    The purpose of this study was to determine the effect of alterations in rate of limb movement on Phase III ventilation during exercise, independent of metabolic rate, gait style, and treadmill incline on a lower body positive pressure treadmill (AlterG P 200). The most important finding was that significant increases in step frequency did not significantly alter minute ventilation or respiratory rate. Such results do not support an important role for the rate of limb movement in Phase III ventilation during submaximal exercise, when metabolic rate, gait style, and treadmill incline are controlled.

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    Physiology & Exercise Science,2015
  • Cutuk A, Groppo E, Quigley E, White K, Pedowitz R, Hargens A. Ambulation in simulated fractional gravity using lower body positive pressure: cardiovascular safety and gait analyses. J Appl Physiol. (1985). 2006 Sep;101(3):771-7.

    SUMMARY
    The purpose of this study is to assess cardiovascular responses to lower body positive pressure (LBPP) and to examine the effects of LBPP unloading on gait mechanics during treadmill ambulation. We hypothesized that LBPP allows comfortable unloading of the body with minimal impact on the cardiovascular system and gait parameters. Ambulating in LBPP has no adverse impact on the systemic and head cardiovascular parameters while producing significant unweighting and minimal alterations in gait kinematics. Therefore, ambulating within LBPP is potentially a new and safe rehabilitation tool for patients to reduce loads on lower body musculoskeletal structures while preserving gait mechanics.

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    Physiology & Exercise Science,2006
  • Evans J, Mohney L, Wang S, Moore RK, Elayi SC, Stenger M, et al. Cardiovascular regulation during body unweighting by lower body positive pressure. Aviat Space Environ Med. 2013 Nov;84(11):1140-6.

    SUMMARY
    This study hypothesizes that human cardiovascular responses to standing in reduced gravity environments, as on the Moon or Mars, could be modeled using a lower body positive pressure (LBPP) chamber. Standing at reduced bodyweight suppressed indexes of sympathetic control of heart rate and peripheral vasomotion. Regulatory responses indicated a combination of arterial and cardiopulmonary baroreflex control: mean heart rate, vasomotion, and baroreflex sensitivity appeared to be more under cardiopulmonary control while baroreflex effectiveness appeared to be driven more by the arterial baroreflex.

    Physiology & Exercise Science,2013
  • Figueroa M, Manning J, Escamilla P. Physiological responses to the AlterG anti-gravity treadmill. Int J Appl Sci Technol. 2011 Nov;1(6):92-97.

    SUMMARY
    The purpose of this study was to determine whether there would be any significant differences in metabolic work when jogging to maximal aerobic capacity on an anti-gravity treadmill, using differential air pressure, at different percentages of body weight (100%, 90% and 80%). Removal of up to 20% bodyweight did not show to alter metabolic responses (VO2, HR, RER) during jogging. Prescribed cardiovascular training intensities can be achieved with a reduction in ground reaction forces in individuals who are overweight, obese or injured. This weight-assisted device may be an effective alternative during rehabilitation or recovery after an event in order to maintain cardiovascular fitness.

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    Physiology & Exercise Science,2011
  • Figueroa M, Wicke J, Manning J, Escamilla P, Santillo N, Wolkstein J, et al. Validation of ACSM metabolic equations in an anti-gravity environment: a pilot study. Int J Appl Sci Technol. 2012 Aug;2(7):204-210.

    SUMMARY
    The purpose of this study was to explore whether the American College of Sports Medicine (ACSM) metabolic formulas (http://certification.acsm.org/metabolic-calcs) that were developed and are used on traditional land-based treadmills would comply with the technology used in the AlterG® anti-gravity treadmill. Significant differences were found during the last 3 stages at 100%BW, stages 2-5 at 90%BW and during all stages at 80%BW with the average measured oxygen consumption values being lower than those that were calculated. A simulated reduction in body weight would elicit training intensities below established guidelines for cardiovascular improvement and weight loss.

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    Physiology & Exercise Science,2012
  • Gojanovic B, Cutti P, Shultz R, Matheson G. Maximal physiologic parameters during partial body-weight support treadmill testing. Med Sci Sports Exerc. 2012 Oct;44(10):1935-41.

    SUMMARY
    This study investigated maximal cardiometabolic response while running in a lower body positive pressure treadmill (antigravity treadmill (AG)), which reduces body weight (BW) and impact. The AG can be used at maximal exercise intensities at BW of 85% to 95%, reaching faster running speeds than normally feasible. The AG could be used for overspeed running programs at the highest metabolic response levels.

    Physiology & Exercise Science,2012
  • Gojanovic B, Shultz R, Feihl F, Matheson G. Overspeed HIIT in lower body positive pressure treadmill improves running performance. Med Sci Sports Exerc. 2015 Dec;47(12):2571-8.

    SUMMARY
    Optimal high-intensity interval training (HIIT) regimens for running performance are unknown, although most protocols result in some benefit to key performance factors (running economy (RE), anaerobic threshold (AT), or maximal oxygen uptake (VO2max)). Lower-body positive pressure (LBPP) treadmills offer the unique possibility to partially unload runners and reach supramaximal speeds. We studied the use of LBPP to test an overspeed HIIT protocol in trained runners. A 4-wk HIIT protocol at 100% vVO2max improves field performance, vVO2max, VO2max and submaximal HR in trained runners. Improvements are similar if intervals are run on a regular treadmill or at higher speeds on a LPBB treadmill with 10% body weight reduction. LBPP could provide an alternative for taxing HIIT sessions.

    Physiology & Exercise Science,2015
  • Grabowski A. Metabolic and biomechanical effects of velocity and weight support using a lower body positive pressure device during walking. Arch Phys Med Rehabil. 2010 Jun;91(6):951-7.

    SUMMARY
    To determine how changes in velocity and weight support affect metabolic power and ground reaction forces (GRFs) during walking using a lower-body positive pressure (LBPP) device. Manipulating velocity and weight using an LBPP device during treadmill walking can reduce force yet maintain cardiorespiratory demand. Thus, LBPP treadmill training devices could be highly effective for rehabilitation after orthopedic injury and/or orthopedic procedures.

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    Physiology & Exercise Science,2010
  • Hoffman M, Donaghe H. Physiological responses to body weight--supported treadmill exercise in healthy adults. Arch Phys Med Rehabil. 2011 Jun;92(6):960-6.

    SUMMARY
    To determine whether the relationships of heart rate, rating of perceived exertion (RPE), and ground reaction forces (GRFs) with oxygen consumption rate (Vo(2)) during treadmill exercise are altered by partial body weight support (BWS) via lower-body positive pressure.

    Because partial BWS does not alter the relationship of heart rate with Vo(2) during exercise and has minimal effect on the relationship of RPE with Vo(2), training heart rate and RPE values do not appear to require adjustment with partial BWS. Reduced GRFs at specified Vo(2) levels from partial BWS suggest that there are important clinical applications of this technology.

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    Physiology & Exercise Science,2011
  • Kostas, VI, Evans, JM et al: Cardiovascular models of simulated moon and mars gravities: head up tilt vs lower body unweighting. Aviat Space Environ. Med 85(4) 414-419. 2014

    SUMMARY
    In this study we compare two models [head-up tilt (HUT) vs. body unweighting using lower body positive pressure (LBPP)] to simulate Moon, Mars, and Earth gravities. We hypothesized that segmental fluid volume shifts (thorax, abdomen, upper and lower leg), cardiac output, and blood pressure (BP), heart rate (HR), and total peripheral resistance to standing would be similar in the LBPP and HUT models. Bodyweight unloading via both LBPP and HUT resulted in cardiovascular changes similar to those anticipated in actual reduced gravity environments. The LBPP model/Alter-G has the advantage of providing an environment that allows dynamic activity at reduced bodyweight; however, the significant increase in blood pressures in the Alter-GC may favor the HUT model.

    Physiology & Exercise Science,2014
  • Liebenberg J, Scharf J, Forrest D, Dufek J, Masumoto K, Mercer J. Determination of muscle activity during running at reduced body weight. J Sports Sci. 2011 Jan;29(2):207-14.

    SUMMARY
    The aim of this study was to investigate how lower extremity muscles are influenced by body weight support during running at different speeds. Reducing body weight leads to a reduction in muscle activity with no changes in muscle activity patterns.

    Physiology & Exercise Science,2011
  • McNeill D, de Heer HD, Bounds RG, Coast JR. Accuracy of unloading with the anti-gravity treadmill. J Strength Cond Res. 2015 Mar;29(3):863-8.

    SUMMARY
    This study evaluated the accuracy of the BW support reported on the AlterG "Anti-Gravity" Treadmill across the spectrum of unloading, from full BW (100%) to 20% BW. These findings suggest that there are significant differences between reported and measured BW support on the AlterG Anti-Gravity Treadmill®, with the largest differences (>5%) found at 100% BW and the greatest BW support (30 and 20% BW). These differences may be associated with changes in metabolic demand and maximum speed during walking or running and should be taken into consideration when using these devices for training and research purposes.

    Physiology & Exercise Science,2015
  • McNeill D, Kline J, de Heer H, Coast J. Oxygen consumption of elite distance runners on an anti-gravity treadmill. J Sport Sci Med. 2015 May 8;14(2):333-9.

    SUMMARY
    This study evaluated how body weight support influenced the relationship between velocity and metabolic cost among 6 elite male distance runners. There is a non-linear decrease in VO2 with increasing BWS. As such, with each increment in the amount of BWS provided, the reduction in VO2 becomes increasingly smaller.

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    Physiology & Exercise Science,2015
  • Mercer J, Applequist B, Masumoto K. Muscle activity during running with different body weight support mechanisms: aquatic environment versus body weight support treadmill. J Sport Rehabil. 2014 Nov;23(4):300-6.

    SUMMARY
    This study compares lower-extremity muscle activity during deep water running and running on an lower body positive pressure treadmill at matched stride frequency. Neither the mechanism of body weight support nor style of deep water running influenced gastrocnemius or tibialis anterior muscle activity during running at the same stride frequency. However, rectus femoris and biceps femoris muscle activity were influenced by not only the mechanism of body weight support but also the style of deep water running.

    Physiology & Exercise Science,2014
  • Mercer J, Applequist B, Masumoto K. Muscle activity while running at 20%-50% of normal body weight. Res Sports Med. 2013;21(3):217-28.

    SUMMARY
    The study aim was to determine how reducing BW by 50%-80% influences muscle activity while running at different speeds. Overall, muscle activity increased with speed and decreased by BW reductions.

    Physiology & Exercise Science,2013
  • Raffalt P, Hovgaard-Hansen L, Jensen B. Running on a lower-body positive pressure treadmill: VO2max, respiratory response, and vertical ground reaction force. Res Q Exerc Sport. 2013 Jun;84(2):213-22.

    SUMMARY
    This study investigated maximal oxygen consumption (VO2max) and time to exhaustion while running on a lower-body positive pressure treadmill (LBPPT) at normal body weight (BW) as well as how BW support affects respiratory responses, ground reaction forces, and stride characteristics. VO2max can be achieved on an LBPPT at 100% BW with an incline-running protocol. The LBPPT is a suitable training device for athletes and allows training at high running speeds and high aerobic stimuli with the benefit of low vGRF and a near-normal movement pattern, although manipulation of gravitational weight causes some adaptations in locomotion.

    Physiology & Exercise Science,2013
  • Sainton P, Nicol C, Cabri J, Barthelemy J, Berton E, Chavet P. Influence of short-term unweighing and reloading on running kinetics and muscle activity. Eur J Appl Physiol. 2015 May;115(5):1135-45.

    SUMMARY
    This study examined the acute effects on running mechanics and lower limb muscle activity of short-term unweighing and reloading conditions while running on a treadmill with a lower body positive pressure (LBPP) device. The unloaded running pattern was characterized by a lower step frequency (due to increased flight time with no change in contact time), lower impact and active force peaks, and also by reduced loading rate and push-off impulse. The combined neuro-mechanical changes suggest that LBPP technology provides runners with an efficient support during the stride.

    Physiology & Exercise Science,2015
  • Simonson S, Shimon J, Long E, Lester B. Using the Alter-G treadmill system with an extremely obese female: a case study. Clinical Kinesiology. 65(2):29-38.

    SUMMARY
    This case study examined the potential use of the AlterG Anti-Gravity Treadmill as treatment modality for extreme obese individuals. The special effect of the treadmill reduces ground reaction forces during walking through the use of lower body positive pressure. The AlterG Treadmill enabled the participant to exercise and walk pain-free at a distance, intensity level, and speed that she could not accomplish while walking on her own and suggests that further study of this modality is warranted.

    Physiology & Exercise Science,2011
  • Smoliga J, Wirfel L, Paul D, Doarnberger M, Ford K. Effects of unweighting and speed on in-shoe regional loading during running on a lower body positive pressure treadmill. J Biomech. 2015 Jul 16;48(10):1950-6.

    SUMMARY
    The purpose of this study was to determine how unweighted running on a lower body positive pressure treadmill (LBPPT) modifies in-shoe regional loading. Linear relationships were found between increases in BWSet (body weight percentage set) and increases in-shoe Fmax (plantar force) and impulse, resulting from regional changes in foot pressure which represent a shift towards forefoot loading, most evident <80% BWSet. Estimating in-shoe regional loading parameters may be useful during rehabilitation and training to appropriately prescribe specific speed and body weight levels, without exceeding certain critical peak force levels while running.

    Physiology & Exercise Science,2011
  • Zhang Q, Knapp C, Stenger M, Patwardhan A, Elayi S, Wang S, et al. Simulations of gravitational stress on normovolemic and hypovolemic men and women. Aviat Space Environ Med. 2014 Apr; 85(4): 407–413.

    SUMMARY
    Earth based simulations of physiologic responses to space mission activities are needed to develop prospective countermeasures. To determine whether upright lower body positive pressure (LBPP) provides a suitable space mission simulation, we investigated cardiovascular responses of normovolemic and hypovolemic, men and women, to supine and orthostatic stress, induced by head-up tilt (HUT) and upright LBPP, representing standing in lunar, Martian and Earth’s gravities. HUT and upright LBPP induced comparable cardiovascular responses, supporting the use of upright LBPP as a potential model to simulate activity in lunar and Martian gravities.

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    Physiology & Exercise Science,2014
  • Berthelsen M, Husu E, Christensen S, Prahm K, Vissing J, Jensen B. Anti-gravity training improves walking capacity and postural balance in patients with muscular dystrophy. Neuromuscul Disord. 2014 Jun;24(6):492-8.

    SUMMARY
    We investigated the functional effects of combined aerobic and strength training in patients with Becker and limb-girdle muscular dystrophies with knee muscle strength levels as low as 3% of normal strength. These results provide evidence that a combination of aerobic and strength training during anti-gravity has the potential to safely improve functional ability in severely affected patients with Becker and limb-girdle muscular dystrophies.

    Neurology,2014
  • Lathan C, Myler A, Bagwell J, Powers C, Fisher B. Pressure-controlled treadmill training in chronic stroke: a case study with AlterG. J Neurol Phys Ther. 2015 Apr;39(2):127-33.

    SUMMARY
    The focus of this case study was to assess the immediate and short-term impact of a pressure-controlled treadmill to improve gait parameters, reduce fall risk, improve participation, and reduce the self-perceived negative impact of stroke in an individual with chronic stroke. Following training, self-selected gait speed increased from 0.50 m/s to 0.96 m/s, as measured by the 10-meter walk test. Stride length increased from 0.58 m to 0.95 m after training and to 1.00 m at 1-month follow-up. Peak hip flexion increased from 3.7° to 24.6° after training and to 19.4° at 1-month follow-up. Peak knee flexion increased from 19.4° to 34.3° after training and to 42.7° at 1-month follow-up. Measures of endurance, fall risk, and percentage of perceived recovery also were found to improve posttraining. Training with a pressure-controlled treadmill may be a viable alternative to traditional body-weight-supported treadmill training for persons poststroke.

    Neurology,2015
  • Kurz M, Corr B, Stuberg W, VolkmanK, Smith N. Evaluation of lower body positive pressure supported treadmill training for children with cerebral palsy. Pediatr Phys Ther. 2011 Fall;23(3):232-9.

    SUMMARY
    This study examined the feasibility of using lower body positive pressure supported (LBPPS) treadmill training to improve the walking abilities, balance and lower extremity strength of children with cerebral palsy (CP). LBPPS treadmill training resulted in significantly faster walking speed, less time in double support, improved overall balance, and strength of the lower extremity antigravity musculature.

    Neurology,2011
  • Kurz M, Stuberg W, DeJong S. Body weight supported treadmill training improves the regularity of the stepping kinematics in children with cerebral palsy. Dev Neurorehabil. 2011;14(2):87-93.

    SUMMARY
    This study examines if body weight supported treadmill training (BWSTT) improves the regularity of stepping kinematics in children with cerebral palsy (CP). BWSTT improved the rhythmical control of the stepping kinematics, preferred walking speed, step length and GMFM score. The improvements in the regularity of the stepping kinematics were strongly correlated with changes in the preferred walking speed, step length and GMFM score.

    Neurology,2011
  • Bugbee W, Pulido P, Goldberg T, DLima D. Use of an Antigravity Treadmill for Rehabilitation After Total Knee Replacement. Bone Joint J. 2013 Dec;95-B(SUPP 34):254.

    SUMMARY
    This study prospectively evaluated the effect of using an antigravity treadmill as an alternative to routine postoperative physical therapy. Twenty-nine patients undergoing unilateral primary TKA were randomized to either gait training (standard outpatient physical therapy) or to the use of an AlterG® antigravity device for gait training for 2 days/week for 4 weeks for a total of 8 therapy sessions. KOOS, TUG and NRS scores improved in both groups but no statistically significant difference was apparent between groups. This initial study demonstrated that an antigravity treadmill device was safe and effective for outpatient postoperative TKA rehabilitation.

    Orthopaedics & Sports Medicine,2013
  • Denning W, Winward J, Pardo M, Hopkins J, Seeley M. Body weight independently affects articular cartilage catabolism. J Sports Sci Med. 2015 Jun; 14(2): 290–296.

    SUMMARY
    The primary purpose of this study was to evaluate the independent effect of BW on articular cartilage catabolism associated with walking. A secondary purpose was to determine how decreased BW influenced cardiovascular response due to walking. Compared to baseline levels, walking with +40% body weight and normal body weight both elicited significant increases in articular cartilage catabolism, while walking with -40% body weight did not. Cardiovascular response (HR and RPE) was not significantly different during walking with normal body weight and when compared to walking with -40% body weight. These results indicate that lower-body positive pressure walking may benefit certain individuals by reducing acute articular cartilage catabolism, due to walking, while maintaining cardiovascular response.

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    Orthopaedics & Sports Medicine,2015
  • Eastlack R, Hargens A, Groppo E, Steinbach G, White K, Pedowitz R. Lower body positive-pressure exercise after knee surgery. Clin Orthop Relat Res. 2005 Feb;(431):213-9.

    SUMMARY
    This study assessed the preliminary feasibility of lower body positive pressure exercise as a rehabilitation technique by examining its effects on gait mechanics and pain, postoperatively. Fifteen patients who had arthroscopic meniscectomy or anterior cruciate ligament reconstruction participated in this study. Patients exercised for 5 minutes at 2.0 mph under three body weight conditions (normal body weight, 60% body weight, and 20% body weight) in random order. Bilateral ground reaction force, electromyographs, and dynamic knee range of motion were collected, and pain was assessed using a visual analog scale. This study showed that lower body positive pressure exercise is effective at reducing ground reaction forces, while safely facilitating gait postoperatively.

    Orthopaedics & Sports Medicine,2005
  • Moore M, Vandenakker-Albanese C, Hoffman M. Use of partial body-weight support for aggressive return to running after lumbar disk herniation: a case report. Arch Phys Med Rehabil. 2010 May;91(5):803-5.

    SUMMARY
    This case report demonstrates the application of partial body-weight supported treadmill running in an aggressive rehabilitation program of an ultramarathon runner who had sustained a lumbar disk herniation. Body-weight supported exercise has recognized value during rehabilitation of lower-extremity injuries. In this case we found that the reductions in vertical loading forces achieved through partial body-weight support can also be valuable in the rehabilitation of an injury above the level of support. This motivated runner successfully used weight-supported treadmill training within 1 week of an acute lumbar disk herniation when he was experiencing considerable pain with unsupported walking and lower-extremity weakness. He continued its use until he adequately improved to allow return to his regular overground running program. This case demonstrates how partial body-weight support can allow aggressive running training early after a lumbar disk injury when normal impact forces cannot be tolerated and when leg weakness is a limitation.

    Orthopaedics & Sports Medicine,2010
  • Patil S, Steklov N, Bugbee W, Goldberg T, Colwell C, D’Lima D. Anti-gravity treadmills are effective in reducing knee forces. J Orthop Res. 2013 May;31(5):672-9.

    SUMMARY
    This study determined the efficacy of an LBPP treadmill in reducing knee forces in vivo. Subjects, implanted with custom electronic tibial prostheses to measure forces in the knee, were tested on a treadmill housed within a LBPP chamber. Peak axial tibiofemoral force ranged from 5.1 times BW at a treadmill speed of 4.5 mph (2.01 m/s) and a pressure setting of 100% BW to 0.8 times BW at 1.5 mph (0.67 m/s) and a pressure setting of 25% BW. Peak knee forces were significantly correlated with walking speed and treadmill reaction force. The LBPP treadmill might be an effective tool in the rehabilitation of patients following lower-extremity surgery. The strong correlation between tibiofemoral force and walking speed and treadmill reaction forces allows for more precisely achieving the target knee forces desired during early rehabilitation.

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    Orthopaedics & Sports Medicine,2010
  • Peeler J, Christian M, Cooper J, Leiter J, MacDonald P. Managing Knee Osteoarthritis: The Effects of Body Weight Supported Physical Activity on Joint Pain, Function, and Thigh Muscle Strength. Clin J Sport Med. 2015 Nov;25(6):518-23.

    SUMMARY
    The aim of this study was to determine the effect of a 12-week lower body positive pressure (LBPP)-supported low-load treadmill walking program on knee joint pain, function, and thigh muscle strength in overweight patients with knee osteoarthritis (OA).

    Participants reported significant improvements in knee joint pain and function and demonstrated significant increases in thigh muscle strength about the degenerative knee. Participants also experienced significant reductions in acute knee pain during full weight bearing treadmill walking and required dramatically less LBPP support to walk pain free on the treadmill. These findings have important implications for the development of nonoperative treatment strategies that can be used in the management of joint symptoms associated with progressive knee OA in at-risk patient populations.

    Orthopaedics & Sports Medicine,2015
  • Saxena A, Granot A. Use of an anti-gravity treadmill in the rehabilitation of the operated achilles tendon: a pilot study. J Foot Ankle Surg. 2011 Sep-Oct;50(5):558-61.

    SUMMARY
    This study’s hypothesis stated, based on prior clinical findings, that being able to run on the AG treadmill at 85% of body weight is sufficient to clear patients to run with full body weight outside. Patients undergoing Achilles tendon rupture or insertional repair surgery were prospectively studied. AlterG patients began their initial run on the treadmill at 70% of their body weight at 13.9 ± 3.4 weeks, 85% at 17.6 ± 3.9 weeks, and outside running at 18.1 ± 3.9 weeks. The control group's return to running outside time was 20.4 ± 4.1 weeks.

    Orthopaedics & Sports Medicine,2011
  • Tenforde A, Wananabe L, Moreno T, Fredericson M. Use of an antigravity treadmill for rehabilitation of a pelvic stress injury. PM R. 2012 Aug;4(8):629-31

    SUMMARY
    This is a case report of a 21-year-old female elite runner who was diagnosed with pelvic stress injury and used an antigravity treadmill during rehabilitation. She was able to return to pain-free ground running at 8 weeks after running at 95% body weight on the antigravity treadmill. Ten weeks from time of diagnosis, she competed at her conference championships and advanced to the NCAA Championships in the 10,000-meters. These findings suggest that use of an antigravity treadmill for rehabilitation of a pelvic stress injury may result in appropriate bone loading and healing during progression to ground running and faster return to competition.

    Orthopaedics & Sports Medicine,2012
  • Webber S, Horvey K, Yurach Pikaluk M, Butcher S. Cardiovascular responses in older adults with total knee arthroplasty at rest and with exercise on a positive pressure treadmill. Eur J Appl Physiol. 2014 Mar;114(3):653-62.

    SUMMARY
    This study investigated cardiovascular responses at rest and during submaximal exercise on a lower body positive pressure treadmill in older adults with total knee arthroplasty (TKA). At rest there were no differences in blood pressure across different treadmill pressures, but heart rate was significantly lower when 30 mmHg was applied compared to ambient pressure conditions (P < 0.05). Participants averaged 5.1 exercise test stages with 0% body weight support (maximum speed 2.5 mph, 0% incline) and 6.4 stages with 40% body weight support (maximum speed 3.0 mph, 10% incline). During exercise, heart rate, systolic blood pressure, oxygen consumption, and minute ventilation were lower when 40% body weight support was provided for a given test stage (P < 0.01). Diastolic blood pressure, knee pain and perceived exertion did not differ with body weight support but increased with increasing exercise test stages (P < 0.05). Provision of body weight support allowed TKA patients to walk at faster speeds and/or to tolerate greater incline with relatively lower levels of heart rate, blood pressure, and oxygen consumption.

    Orthopaedics & Sports Medicine,2014
  • Wilk K, Macrina L, Cain L, Dugas J, Andrews J. Recent advances in the rehabilitation of anterior cruciate ligament injuries. J Orthop Sports Phys Ther. 2012 Mar;42(3):153-71.

    SUMMARY
    Rehabilitation following anterior cruciate ligament surgery continues to change, with the current emphasis being on immediate weight bearing and range of motion, and progressive muscular strengthening, proprioception, dynamic stability, and neuromuscular control drills. The rehabilitation program should be based on scientific and clinical research and focus on specific drills and exercises designed to return the patient to the desired functional goals. The goal is to return the patient's knee to homeostasis and the patient to his or her sport or activity as safely as possible. Unique rehabilitation techniques and special considerations for the female athlete will also be discussed. The purpose of this article is to provide the reader with a thorough scientific basis for anterior cruciate ligament rehabilitation based on graft selection, patient population, and concomitant injuries.

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    Orthopaedics & Sports Medicine,2012
  • Wilk K, Macrina L, Leonard C, Reinold M. Rehabilitation following microfracture of the knee. Cartilage. 2010 Apr; 1(2): 96–107.

    SUMMARY
    Postoperative rehabilitation programs following articular cartilage repair procedures will vary greatly among patients and need to be individualized based on the nature of the lesion, the unique characteristics of the patient, and the type and detail of each surgical procedure. These programs are based on knowledge of the basic science, anatomy, and biomechanics of articular cartilage as well as the biological course of healing following surgery. The goal is to restore full function in each patient as quickly as possible by facilitating a healing response without overloading the healing articular cartilage. The purpose of this article is to overview the principles of rehabilitation following microfracture procedures of the knee.

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    Orthopaedics & Sports Medicine,2012
  • Physiology & Exercise Science

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