Sports Medicine

, Volume 47, Issue 2, pp 261–275 | Cite as

Physiological and Biomechanical Responses to Running on Lower Body Positive Pressure Treadmills in Healthy Populations

  • Kathryn A. Farina
  • Alexis A. Wright
  • Kevin R. Ford
  • Leah Anne Wirfel
  • James M. SmoligaEmail author
Systematic Review



Lower body positive pressure treadmills (LBPPTs) aim to reduce musculoskeletal loading during running. As LBPPTs have become more commercially available, they have become integrated into athletic performance and clinical rehabilitation settings. Consequentially, published research examining the biomechanical and physiological responses to unweighted running has increased.


The purpose of this systematic review was to synthesize the literature in an attempt to provide researchers and clinicians with a comprehensive review of physiologic and biomechanical responses to LBPPT running.


Through a generic search of PubMed, CINAHL, MEDLINE, and SPORTDiscus using a comprehensive list of search terms related to LBPPT, unweighting, and body weight support during running, we identified all peer-reviewed publications that included LBPPT running. Two reviewers independently evaluated the quality of studies using a modified Downs and Black checklist for non-randomized studies.


A total of 15 articles met the inclusion criteria for this review. Peak and active vertical ground-reaction forces were consistently reduced with unweighting, but regional loading within the foot was also altered towards a forefoot strike. LBPPTs also provide some horizontal assistance. Neuromuscular activation is generally reduced with LBPPTs, but the stabilizer muscle groups may respond differently than the propulsive muscle groups. Submaximal heart rate and volume oxygen consumption are reduced with unweighting, but physiologic response remains generally unchanged at maximal intensities.


The current literature suggests that LBPPTs are effective in allowing individuals to achieve a given metabolic stimulus with reduced musculoskeletal loading. However, LBPPTs not only reduce impact but also change neuromuscular activation and biomechanics in a complex manner. Thus, clinicians must account for the specific biomechanical and physiological alterations induced by LBPPTs when designing training programs and rehabilitation protocols.


Plantar Fasciitis Stride Frequency Body Weight Support Neuromuscular Activation Impact Peak 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Compliance with Ethical Standards


No sources of funding were used to assist in the preparation of this article.

Conflict of interest

Kathryn Farina, Alexis Wright, Kevin Ford, Leah Anne Wirfel, and James Smoliga have no conflicts of interest relevant to the content of this review.

Supplementary material

40279_2016_581_MOESM1_ESM.docx (17 kb)
Supplementary material 1 (DOCX 16 kb)


  1. 1.
    Pierpoint LA, Williams CM, Fields SK, et al. Epidemiology of injuries in United States High School Track and Field: 2008–2009 through 2013–2014. Am J Sports Med. 2016;44(6):1463–8.CrossRefPubMedGoogle Scholar
  2. 2.
    Kerr ZY, Kroshus E, Grant J, et al. Epidemiology of National Collegiate Athletic Association men’s and women’s cross-country injuries, 2009–2010 through 2013–2014. J Athl Train. 2016;51(1):57–64.CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Hauret KG, Bedno S, Loringer K, et al. Epidemiology of exercise- and sports-related injuries in a population of young, physically active adults: a survey of military service members. Am J Sports Med. 2015;43(11):2645–53.CrossRefPubMedGoogle Scholar
  4. 4.
    Kluitenberg B, van Middelkoop M, Smits DW, et al. The NLstart2run study: Incidence and risk factors of running-related injuries in novice runners. Scand J Med Sci Sports. 2015;25(5):e515–23.CrossRefPubMedGoogle Scholar
  5. 5.
    Nielsen RO, Ronnow L, Rasmussen S, et al. A prospective study on time to recovery in 254 injured novice runners. PLoS One. 2014;9(6):e99877.CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Changstrom BG, Brou L, Khodaee M, et al. Epidemiology of stress fracture injuries among US high school athletes, 2005–2006 through 2012–2013. Am J Sports Med. 2015;43(1):26–33.CrossRefPubMedGoogle Scholar
  7. 7.
    Wright AA, Taylor JB, Ford KR, et al. Risk factors associated with lower extremity stress fractures in runners: a systematic review with meta-analysis. Br J Sports Med. 2015;49(23):1517–23.CrossRefPubMedGoogle Scholar
  8. 8.
    van der Worp MP, ten Haaf DS, van Cingel R, et al. Injuries in runners; a systematic review on risk factors and sex differences. PLoS One. 2015;10(2):e0114937.CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Saragiotto BT, Yamato TP, Hespanhol Junior LC, et al. What are the main risk factors for running-related injuries? Sports Med. 2014;44(8):1153–63.CrossRefPubMedGoogle Scholar
  10. 10.
    Davis IS, Bowser BJ, Mullineaux DR. Greater vertical impact loading in female runners with medically diagnosed injuries: a prospective investigation. Br J Sports Med. 2015;. doi: 10.1136/bjsports-2015-094579.Google Scholar
  11. 11.
    Schlabs T, Rosales-Velderrain A, Ruckstuhl H, et al. Comparison of cardiovascular and biomechanical parameters of supine lower body negative pressure and upright lower body positive pressure to simulate activity in 1/6 G and 3/8 G. J Appl Physiol (1985). 2013;115(2):275–84.Google Scholar
  12. 12.
    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;50(5):558–61.Google Scholar
  13. 13.
    Tenforde AS, Watanabe LM, Moreno TJ, et al. Use of an antigravity treadmill for rehabilitation of a pelvic stress injury. PM R. 2012;4(8):629–31.CrossRefPubMedGoogle Scholar
  14. 14.
    Moore MN, Vandenakker-Albanese C, Hoffman MD. Use of partial body-weight support for aggressive return to running after lumbar disk herniation: a case report. Arch Phys Med Rehabil. 2010;91(5):803–5.CrossRefPubMedGoogle Scholar
  15. 15.
    Grabowski AM, Kram R. Effects of velocity and weight support on ground reaction forces and metabolic power during running. J Appl Biomech. 2008;24(3):288–97.CrossRefPubMedGoogle Scholar
  16. 16.
    Raffalt PC, Hovgaard-Hansen L, Jensen BR. Running on a lower-body positive pressure treadmill: VO2max, respiratory response, and vertical ground reaction force. Res Q Exerc Sport. 2013;84(2):213–22.CrossRefPubMedGoogle Scholar
  17. 17.
    Moher D, Liberati A, Tetzlaff J, et al. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. BMJ. 2010;8(5):336–41.Google Scholar
  18. 18.
    Downs SH, Black N. The feasibility of creating a checklist for the assessment of the methodological quality both of randomised and non-randomised studies of health care interventions. J Epidemiol Community Health. 1998;52(6):377–84.CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    Cutuk A, Groppo ER, Quigley EJ, et al. Ambulation in simulated fractional gravity using lower body positive pressure: cardiovascular safety and gait analyses. J Appl Physiol. 2006;101(3):771–7.CrossRefPubMedGoogle Scholar
  20. 20.
    Sainton P, Nicol C, Cabri J, et al. Influence of short-term unweighing and reloading on running kinetics and muscle activity. Eur J Appl Physiol. 2015;115(5):1135–45.CrossRefPubMedGoogle Scholar
  21. 21.
    Smoliga JM, Wirfel LA, Paul D, et al. Effects of unweighting and speed on in-shoe regional loading during running on a lower body positive pressure treadmill. J Appl Biomech. 2015;48(10):1950–6.CrossRefGoogle Scholar
  22. 22.
    Hoffman MD, Donaghe HE. Physiological responses to body weight: supported treadmill exercise in healthy adults. Arch Phys Med Rehabil. 2011;92(6):960–6.CrossRefPubMedGoogle Scholar
  23. 23.
    Gojanovic B, Cutti P, Shultz R, et al. Maximal physiological parameters during partial body-weight support treadmill testing. Med Sci Sports Exerc. 2012;44(10):1935–41.CrossRefPubMedGoogle Scholar
  24. 24.
    Hunter I, Seeley MK, Hopkins JT, et al. EMG activity during positive-pressure treadmill running. J Electromyogr Kinesiol. 2014;24(3):348–52.CrossRefPubMedGoogle Scholar
  25. 25.
    Liebenberg J, Scharf J, Forrest D, et al. Determination of muscle activity during running at reduced body weight. J Sports Sci. 2011;29(2):207–14.CrossRefPubMedGoogle Scholar
  26. 26.
    Mercer JA, Applequist BC, Masumoto K. Muscle activity while running at 20 %–50 % of normal body weight. Res Sports Med. 2013;21(3):217–28.PubMedGoogle Scholar
  27. 27.
    Kline JR, Raab S, Coast JR, et al. A conversion table for running on lower body positive pressure (LBPP) treadmills. J Strength Cond Res. 2015;29(3):854–62.CrossRefPubMedGoogle Scholar
  28. 28.
    McNeill DK, de Heer HD, Williams CP, et al. Metabolic accommodation to running on a body weight-supported treadmill. Eur J Appl Physiol. 2015;115(5):905–10.CrossRefPubMedGoogle Scholar
  29. 29.
    McNeill DK, Kline JR, de Heer HD, et al. Oxygen consumption of elite distance runners on an anti-gravity treadmill(R). J Sports Sci Med. 2015;14(2):333–9.PubMedPubMedCentralGoogle Scholar
  30. 30.
    Ruckstuhl H, Kho J, Weed M, et al. Comparing two devices of suspended treadmill walking by varying body unloading and Froude number. Gait Posture. 2009;30(4):446–51.CrossRefPubMedGoogle Scholar
  31. 31.
    Gojanovic B, Shultz R, Feihl F, et al. Overspeed HIIT in lower body positive pressure treadmill improves running performance. Med Sci Sports Exerc. 2015;47(12):2571–8.CrossRefPubMedGoogle Scholar
  32. 32.
    Chang YH, Hamerski CM, Kram R. Applied horizontal force increases impact loading in reduced-gravity running. J Biomech. 2001;34(5):679–85.CrossRefPubMedGoogle Scholar
  33. 33.
    Chang YH, Kram R. Metabolic cost of generating horizontal forces during human running. J Appl Physiol (1985). 1999;86(5):1657–62.Google Scholar
  34. 34.
    McNeill DK, de Heer HD, Bounds RG, et al. Accuracy of unloading with the Anti-Gravity (R) treadmill. J Strength Cond Res. 2015;29(3):863–8.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2016

Authors and Affiliations

  • Kathryn A. Farina
    • 1
  • Alexis A. Wright
    • 2
  • Kevin R. Ford
    • 2
  • Leah Anne Wirfel
    • 3
  • James M. Smoliga
    • 2
    Email author
  1. 1.Department of Exercise ScienceHigh Point UniversityHigh PointUSA
  2. 2.Department of Physical TherapyHigh Point UniversityHigh PointUSA
  3. 3.Department of Physical TherapySlippery Rock UniversitySlippery RockUSA

Personalised recommendations