Far too little attention has been paid to health effects of air pollution and physical (in)activity on musculoskeletal health. The purpose of the Healthy aging in industrial environment study (4HAIE) is to investigate the potential impact of physical activity in highly polluted air on musculoskeletal health. A total of 1500 active runners and inactive controls aged 18–65 will be recruited. The sample will be recruited using quota sampling based on location (the most air-polluted region in EU and a control region), age, sex, and activity status. Participants will complete online questionnaires and undergo a two-day baseline laboratory assessment, including biomechanical, physiological, psychological testing, and magnetic resonance imaging. Throughout one-year, physical activity data will be collected through Fitbit monitors, along with data regarding the incidence of injuries, air pollution, psychological factors, and behavior collected through a custom developed mobile application. Herein, we introduce a biomechanical and musculoskeletal protocol to investigate musculoskeletal and neuro-mechanical health in this 4HAIE cohort, including a design for controlling for physiological and psychological injury factors. In the current ongoing project, we hypothesize that there will be interactions of environmental, biomechanical, physiological, and psychosocial variables and that these interactions will cause musculoskeletal diseases/protection.

In large cohort studies, due to the time-consuming nature of the measurement of movement biomechanics, more than one evaluator needs to be involved. This may increase the potential occurrence of error due to inaccurate positioning of markers to the anatomical locations. The purpose of this study was to determine the reliability and objectivity of lower limb segments length by multiple evaluators in a large cohort study concerning healthy aging in an industrial environment. A total of eight evaluators performed marker placements on five participants on three different days. Evaluators placed markers bilaterally on specific anatomical locations of the pelvis, thigh, shank and foot. On the right foot, markers were placed in anatomical locations to define a multi-segmental foot model. The position of the marker at the anatomical locations was recorded by a motion capture system. The reliability and objectivity of lower limb segment lengths was determined by the intraclass correlation coefficient of a two-way random model and of the two-way mixed model, respectively. For all evaluators for all segments, the average reliability and objectivity was greater than 0.8, except for the metatarsus segment (0.683). Based on these results, we can conclude that multiple evaluators can be engaged in a large cohort study in the placement of anatomical markers.

Background: Regular walking in different types of footwear may increase the mediolateral shear force, knee adduction moment, or vertical ground-reaction forces that could increase the risk of early development of knee osteoarthritis (OA). Purpose: To compare kinematic and kinetic parameters that could affect the development of knee OA in 3 footwear conditions. Study Design: Controlled laboratory study. Methods: A total of 40 asymptomatic participants performed walking trials in the laboratory at self-selected walking speeds under barefoot (BF), minimalistic (MF), and neutral (NF) footwear conditions. Knee joint parameters were described using discrete point values, and continuous curves were evaluated using statistical parametric mapping. A 3 × 1 repeated-measures analysis of variance was used to determine the main effect of footwear for both discrete and continuous data. To compare differences between footwear conditions, a post hoc paired t test was used. Results: Discrete point analyses showed a significantly greater knee power in NF compared with MF and BF in the weight absorption phase ( P < .001 for both). Statistical parametric mapping analysis indicated a significantly greater knee angle in the sagittal plane at the end of the propulsive phase in BF compared with NF and MF ( P = .043). Knee joint moment was significantly greater in the propulsive phase for the sagittal ( P = .038) and frontal planes ( P = .035) in BF compared with NF and MF and in the absorption phase in the sagittal plane ( P = .034) in BF compared with MF and NF. A significant main effect of footwear was found for anteroposterior (propulsion, ↑MF, NF, ↓BF [ P = .008]; absorption, ↑BF, MF, ↓NF [ P = .001]), mediolateral (propulsion, ↑MF, NF, ↓BF [ P = .005]; absorption, ↑NF, MF, ↓BF [ P = .044]), and vertical (propulsion, ↑NF, BF, ↓MF [ P = .001]; absorption, ↑MF, BF, ↓NF [ P < .001]) ground-reaction forces. Knee power showed a significant main effect of footwear (absorption, ↑NF, MF, ↓BF [ P = .015]; propulsion, ↑MF, NF, ↓BF [ P = .039]). Conclusion: Walking in MF without sufficient accommodation affected kinetic and kinematic parameters and could increase the risk of early development of knee OA.

Background: Walking in minimalistic footwear (MF) increases mechanical loading on the knee joint, exposing it to acute stresses that may heighten the risk of early onset of knee osteoarthritis. This type of footwear can modify walking patterns in the lower limbs, further intensifying joint stress and contributing to the deterioration of articular surfaces. Purpose: First, to evaluate the differences in kinetic variables associated with the early onset of knee osteoarthritis between MF and neutral footwear (NF) during walking; second, to determine the extent of acute cartilage loading in the knee joint, particularly footwear after 45 minutes of walking in an urban environment, using magnetic resonance imaging (T2 relaxation times [T2RTs] and percentage change of loading) in weightbearing zones. Study Design: Controlled laboratory study. Methods: Knee forces and knee moments were obtained during walking trials of 20 healthy participants using statistical parametric mapping. The analysis focused on alterations across specific intervals of the stance phase, expressed as percentages of the gait cycle. T2RT values of cartilage were quantified using a 1.5 T magnetic resonance imaging at baseline and immediately after 45 minutes of walking in each condition. Results: Significant differences were observed in knee force during the stance phase: (1) in the sagittal plane, greater values were between 2% and 9% and between 90% and 100%, and lower values were between 18% and 40% and between 62% and 85% in MF; (2) the frontal plane showed lower values between 7% and 14% and 98% in MF, and greater values were between 7% and 14% and 98% in MF; and (3) the transversal plane showed greater values between 0% and 9% and between 54% and 78%, and lower values were between 25% and 40% and between 81% and 100% in MF. Knee adduction moment showed significantly lower values between 0% and 8%, 32% and 90%, and >92% and 100%. Knee flexion moment showed significantly lower values between 3% and 5%, 25% and 69%, and >7% and 19% in MF. The main effect of loading in NF of cartilage showed significantly lower T2RT values in all superficial femur parts and significantly greater T2RT values in deep central tibia. MF showed significantly lower T2RT values in the superficial anterior-posterior femur in the medial cartilage compartment. Conclusion: Increased knee moments in all planes reflect the effect of an acute change to particular footwear. NF reveals a greater response to loading in weightbearing knee cartilage zones. The superficial layers appeared to be more sensitive to loading after 45 minutes of walking.