Effect of Backpack Loads on the Timing of Cardiopulmonary Response
in Healthy Men
CHUNGIL LEE1, JIHO CHOI1, HOJOON JO1, JIYEON LEE2, DONGYEOP LEE1,
JIHEON HONG1, JAEHO YU1, SEONGGIL KIM1, JINSEOP KIM1,*
1Department of Physical Therapy,
Sunmoon University,
Chungcheongnam-do, Asan-si,
SOUTH KOREA
2Digital Healthcare Research Institute,
Sunmoon University,
Chungcheongnam-do, Asan-si,
SOUTH KOREA
*Corresponding Author
Abstract: - The backpack used commonly affects posture and physical performance, resulting in increased
oxygen uptake and energy expenditure. The purpose of this study is to confirm the effect of the chest loads on
the reaching time of the cardiopulmonary response. Seventeen healthy men participants were monitored for
cardiopulmonary function continuously during walking exercise with the Ramp protocol and recorded the time
taken to reach THR, VO2 peak, RR Difference, maximal METs, maximal FECO2, and minimum FEO2. During
the exercise test, subjects were instructed to carry a backpack loaded at no load, 5%, 10%, and 15% body
weight in random order. There was a significant difference in the time to reach the THR, the oxygen intake
peak time, the maximum metabolic equivalent time, the respiratory rate increase, the minimum oxygen amount,
and the maximum carbon dioxide amount at no load and more than 5% load. However, no significant
difference was found between the loads. It is thought that even a 5% backpack load of one's body weight can
impose on cardiopulmonary energy costs, and this is thought to help improve training programs with a gradual
increase in mechanical chest load.
Key-Words: - Load carriage, Cardiopulmonary function, Backpack, Weight, CPX, Ramp protocol.
Received: August 13, 2023. Revised: January 3, 2024. Accepted: February 8, 2024. Published: April 4, 2024.
1 Introduction
To breathe, oxygen is inhaled and delivered into the
bloodstream, and carbon dioxide is expelled through
exhalation after the oxygen has been consumed by
the body’s energy metabolism, [1], [2]. During
resistive loaded breathing, an appropriate central
nervous respiratory output response and respiratory
system mechanical properties like chest wall
stability and respiratory muscle strength induce
effective tidal volume and minute ventilation, [3].
Backpack-carrying is one of the essential
methods of transporting occupational items and is
essential in many physically demanding
occupations, with first responders and military
personnel carrying the heaviest loads, [4], [5], [6].
As the popularity of adventure sports, recreational
activities, and mountaineering increases, the use of
backpack carrying has expanded, [7], [8]. Thus,
various studies have been conducted to investigate
the effects of backpack-carrying systems on
biomechanics such as posture and gait patterns
depending on occupation and type of sports activity.
Backpack load carriage affects physical
performance by loading the spine symmetrically and
changing the forward tilting trunk inclination and
body center of gravity (COG), [9], [10], [11].
According to the previous study, which checked
changes in gait patterns, heart rate, and blood
pressure by having male students carrying various
backpack loads at waist height walk on a treadmill,
the anterior tilting angle of trunk increased with
loads of 15% and 20% body weight (BW) compared
to no load and 10% BW, and a prolonged blood
pressure recovery time was observed, [12].
In addition to the shape of the backpack, the
thickness of the straps and the wearing style (single
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Chungil Lee, Jiho Choi, Hojoon Jo,
Jiyeon Lee, Dongyeop Lee, Jiheon Hong,
Jaeho Yu, Seonggil Kim, Jinseop Kim
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or double) have different degrees of restriction on
the chest, [13], [14]. Load carriage systems such as
jackets or backpacks that cover the entire trunk from
front to back reduce pulmonary function greatly,
[15]. Restriction of the chest decreases the
satisfaction and quality of distinct respiratory
sensations, including difficulty inhalation and
uncomfortable shallow breathing, [16], [17].
Carrying a load close to the body, such as a
backpack, affects lung function by restricting the
movement of the chest wall during breathing, due to
the structural frame, harness type, and weight of the
backpack, [13], [18], [19]. These studies suggested
that considering backpack-wearing positioning to
optimize the effects on body biomechanics and
pulmonary functions, positioning it close to the
body promotes anteroposterior and lateral stability
by facilitating the body’s large muscle groups, [14],
[20], [21].
In the preceding paper studies, the effects of
unloading and large loads of absolute figures of 15
kg, 30 kg, and 45 kg on cardiopulmonary abilities
were presented, [22], [23]. But if you look at most
of these prior studies, you can only mention the
effects of absolute numerical load on
cardiopulmonary functions, and you can't see the
effects of proportional load on relative load on
cardiopulmonary functions.
There have been previous studies that
investigated the effect of backpack chest load on
cardiopulmonary function values, but there were no
studies that confirmed the timing of the target
cardiopulmonary response. Therefore, the purpose
of this study is to compare the effect of backpack
load by examining the time to reach the
cardiopulmonary function response.
2 Methods
2.1 Participants
Seventeen healthy males participated in this study.
This study was approved by the Sunmoon
University Institutional Bioethics Committee (SM-
201904-019-1), and all procedures were performed
after subjects provided written consent for
participation. All subjects had no history of
cardiopulmonary disease and musculoskeletal
disorders and had normal pulmonary function.
2.2 Procedures
This study was completed with repeated
measurement within-subject studies. Subjects
underwent basic anthropometric measurements
(height, weight). Subjects wore the same training
suit (sports pants, T-shirts, and running shoes) and
completed four randomly ordered exercise tests with
backpack load: unload, 5%, 10%, and 15% of body
weight (BW) loads (Figure 1). Since there is a
concern about wearing backpacks heavier than 20%
of the BW, our study set the lower level up to 15%
of BW to avoid injury risk and not to cause
musculoskeletal problems, [24], [25].
A conventional double-strap backpack with a
capacity of 25L was selected in this study (John
Sports Backpack Super Brake, T501008). The
backpack was positioned on the spine T12 to ensure
consistency while inducing a large postural response
to the load, [26]. The exercise test was started at the
Resting Heart Rate (RHR) by applying the Ramp
protocol until 85% of the Target heart rate (THR).
The Ramp protocol in the Electric Running
Machines (Standard Industries, Fargo, ND, USA)
adjusts belt speeds linearly from approximately
0.5mph up to 3.0mph within the participant’s
comfortable walking range with low exercise
tolerance. The subjects completed a separate
exercise while wearing a backpack with unloading,
5%, 10%, and 15% of BW loads randomly. The
subjects were conducted with a warm-up (3
minutes), cool-down (3 minutes), and an hour break
for recovery.
Fig. 1: Experiment protocol flow chart
2.3 Measures
A cardiopulmonary exposure test (CPX) was
utilized to measure cardiopulmonary functions,
Blood pressure (BP), Heart rate (HR), Oxygen
consumption peak (VO2 peak), Respiratory rate
(RR), Metabolic equivalents (METs), Fractional
concentration of carbon dioxide in expired gas
(FECO2), and Fractional concentration of oxygen in
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Chungil Lee, Jiho Choi, Hojoon Jo,
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expired gas (FEO2). Cardiopulmonary functions
(HR, VO2 peak, RR, METs, FECO2, and FEO2)
were analyzed for each breath. The data averaged
over 30 seconds were measured and BP was
measured every 2 minutes. To analyze the
cardiopulmonary function reactions during the
exercise tests with four backpack loads conditions,
unweighted, 5%, 10%, and 15% of BW, the time to
reach THR, VO2 peak, RR Difference, maximal
METs, maximal FECO2, minimum FEO2 was
recorded.
All tests were conducted in a laboratory with
similar humidity (40 to 65%) and temperature (21 to
23 ). We asked the participants to drink 150ml of
cool water during rest. The researchers continuously
checked the condition of the subjects (heart rate,
blood pressure, motor stress, and ECG) and
immediately stopped the experiment if abnormal
conditions were observed.
2.4 Statistical Analysis
Statistical analysis was calculated using SPSS
version 20.0 for Windows (SPSS INC, Chicago, IL).
The repeated measured ANOVA was used to
compare the recorded time to reach THR, VO2 peak,
RR Difference, maximal METs, maximal FECO2,
and minimum FEO2 to investigate the effects of
backpack load conditions (unload, 5%, 10%, and
15% of BW load). Bonferroni was used to examine
relationships between variables of interest. All
statistical significance levels were set at p<.05 for
statistical analysis.
3 Results
General characteristics and measures according to
the weight loads for the subjects are listed in Table 1
and Table 2, respectively.
Table 1. General characteristicsof the subject
3.1 The Time to Reach the Target Heart
Rate
The time to reach the THR showed a significant
difference between unloading and 5%, 10%, and
15% loads (p<.05), although there was also a
significant difference between unloading and 10%,
unloading and 15% (p<.05) There was no significant
difference between 10% and 15% (p>.05). In other
words, as the load increases, the time to reach the
target heart rate between the loads decreased, no
significant difference between the 10% and 15%
loads was found (p>.05). As a result of the post-test,
the time to reach THR between unload and 5% load
decreased the most (Figure 2).
Fig. 2: THR according to load
Table 2. Means and standard deviation values by backpack loads
2
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The analysis of the time to reach VO2 peak showed
a significant difference between unload and 5%,
unload and 10%, unload and 15% load, 5% and 15%
load each (p<.05). There was no between 5% and
10% load, 10% and 15% load each (p>.05). As a
result of the post-test, the time to reach VO2 peak
between unload and 5% load decreased the most
(Figure 3).
Fig. 3: VO2
peak according to load
3.3 Respiratory Rate Difference
The analysis of the increase in the RR for each load
showed no significant difference between unload,
5%, 10%, and 15% loads (p>.05) (Figure 4).
Fig. 4: RR according to load
3.4 The Time to Reach Maximal METs
The time to reach the maximal METs showed a
significant difference between unload and 5%,
unload and 10%, unload and 15% load, 5% and 15%
load each (p<.05). No significant difference between
5% and 10% load, 10% and 15% load each was
shown (p>.05). As a result of the post-test, the time
to reach maximal METs between the unload and the
5% load decreased the most (Figure 5).
Fig. 5: METs according to load
3.5 The Time to Reach Maximal FECO2 and
Minimum FEO2
The time to reach the maximal FECO2, and
minimum FEO2 showed a significant difference
between unload and 5%, unload and 10%, unload
and 15% load, and 5% and 15% load each (p<.05).
There was no significant difference between 5% and
10% load, 10% and 15% load each (p>.05). As a
result of the post-test, the time to reach the maximal
FECO2 (minimal FEO2) between unload and 5%
load decreased the most (Figure 6).
Fig. 6: FECO2
, FEO2
according to load
4 Discussion
This study compared the time of reaching THR,
VO2 peak, RR Difference, maximal METs, maximal
FECO2, and minimum FEO2 under four backpack
load conditions in 17 healthy men.
As a result, there was a significant difference in
the THR reaching time, VO2 peak reaching time,
maximal METs reaching time, minimum FEO2, and
maximum FECO2 reaching time between unload
and load conditions.
Chest load carriage via vest or backpack has
been shown to place mechanical restrictions on
respiratory muscles, reducing respiratory efficiency
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3.2 The Time to Reach VO2 Peak
[27], [28]. Chest load increases energy expenditure
along with oxygen consumption as load increases
during activity [29]. In this study, it was observed
that as the load weight increased, the reaching time,
which indicates a change in cardiopulmonary
physiological response, became faster. Previous
studies have shown that the torque-generating
capacity of ankle plantar flexors and knee extensors
is reduced by dynamometers before and after load
carriage transporting [30].
Reduced knee extensor strength during load
carrying leads to a less economical gait pattern, but
increased muscle fiber recruitment required to
maintain movement leads to increased VO2, [31],
[32], [33].
This supports the results of this study, which
showed that the time to reach THR, VO2 peak,
maximum MET, RR, maximum FECO2, and
minimum FEO2 became shorter as the load
increased.
A recent 25kg chest load carriage showed
increased ventilation during continuous movement
(45 minutes at 68% VO2 peak), [34]. In a previous
study examining peak performance and
cardiometabolic responses to vest-wearing load
carrying among U.S. Army soldiers, peak walking
speed gradually and significantly decreased as vest
load increased, increasing the physiological cost of
carrying, [35]. The metabolic and motivational
effects of a load of 30-70% of body weight were
determined while walking at a constant speed on a
treadmill, [36], with an increase in load
systematically increasing transport energy costs
(VO2, RPE, and HR), [6]. On the other hand, in
some studies, the increase in metabolic rate during
exercise with progressive loads (15 to 45 kg) did not
show a systematic linear proportion to the change in
backpack weight, [23]. These results indicate the
concept that the physiological response to a load
depending on the characteristics of the load is not
uniform. The results of this study showed that as the
load increased from no load, the time to reach THR,
VO2 peak, maximal METs, and maximal FECO2,
minimal FEO2 gradually became shorter.
Particularly, there was a significant difference
between no load and 5% and 15% load conditions,
which supports the results that the above-mentioned
load affects physiological responses.
For the Respiratory Rate, there was no
significant difference in the increase in the
Respiratory Rate between the load and the unload,
and there was no significant difference between the
loads. Exercise induces increased ventilation
through increases in respiratory rate and tidal
volume. An increase in tidal volume is achieved
through a gradual increase in end-inspiratory lung
volume while the end-expiratory lung volume
decreases, [37], [38]. However, a study comparing
backpack load conditions during exercise with
matched oxygen demand found no difference in
lung volume and minute ventilation between load
conditions during the first 10 minutes after starting
exercise, [39]. During the exercise test in this study,
to see rapid changes in response, a ramp protocol
was used to change the incline and speed, resulting
in a shorter exercise time than regular treadmill
walking. In addition, when the ventilatory threshold
is reached during exercise under no load and various
load conditions, the rate of increase in oxygen
intake slowly decreases, which is thought to have
affected the respiratory rate.
Our research team suggested that as little as 5%
backpack load showed significant difference in the
THR reached, VO2 peak reached, maximal METs
reached, Respiratory Rate, maximal FECO2, and
minimal FEO2. Therefore, to reduce the burden of
cardiopulmonary ability, even if 5% of the body
weight was not applied, the backpack load could be
less than the load.
This study has some limitations. First, although
random loading was selected, and sufficient rest was
given between measurements, the measured values
may be changed due to the subject's compliance and
fatigue due to repeated measurements. Second, we
set up a target for stopping the exercise of RHR +
(MHR-RHR) * 0.85, which is the THR. Third, all
subjects were normal males in their 20s and cannot
be generalized to patients or all age groups.
5 Conclusion
The purpose of this study was to compare
differences in cardiopulmonary responses in healthy
men under backpack loading conditions and showed
that there were significant differences in THR reach
time, VO2 peak reach time, maximum METs reach
time, minimum FEO2, maximum FECO2 according
to load. That is, an increase in backpack load of
even 5% of body weight triggers a cardiopulmonary
response, and these findings suggest that gradually
increasing mechanical loading on anatomical
structures may help improve injury rehabilitation
and monitor training programs.
Acknowledgement:
The authors would like to thank the participants for
their time and dedication to the project.
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Abbreviations:
THR: Target Heart Rate (time)
VO2 peak: Oxygen consumption peak (time)
RR: Respiratory Rate
METs: Metabolic equivalents (time)
FECO2: Fractional concentration of carbon dioxide
in expired gas (maximal time)
FEO2: Fractional concentration of oxygen in
expired gas (minimal time)
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WSEAS TRANSACTIONS on BIOLOGY and BIOMEDICINE
DOI: 10.37394/23208.2024.21.18
Chungil Lee, Jiho Choi, Hojoon Jo,
Jiyeon Lee, Dongyeop Lee, Jiheon Hong,
Jaeho Yu, Seonggil Kim, Jinseop Kim
E-ISSN: 2224-2902
176
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Contribution of Individual Authors to the
Creation of a Scientific Article (Ghostwriting
Policy)
- Lee Chungil, Choi Jiho, and Jo Hojoon organized
the study design and carried out the experiments.
- Lee Jieyon, and Lee Dongyeop were responsible
for interpreting the study results and organizing
references.
- Hong Jiheon, Yu Jaeho, and Kim Seonggil
oversaw interpreting the results of the study and
scheduling the overall progress.
- Kim Jinseop fine-tuned the research design and
searched for prior research.
Sources of Funding for Research Presented in a
Scientific Article or Scientific Article Itself
No funding was received for conducting this study.
Conflict of Interest
The authors have no conflicts of interest to declare.
Creative Commons Attribution License 4.0
(Attribution 4.0 International, CC BY 4.0)
This article is published under the terms of the
Creative Commons Attribution License 4.0
https://creativecommons.org/licenses/by/4.0/deed.en
_US
WSEAS TRANSACTIONS on BIOLOGY and BIOMEDICINE
DOI: 10.37394/23208.2024.21.18
Chungil Lee, Jiho Choi, Hojoon Jo,
Jiyeon Lee, Dongyeop Lee, Jiheon Hong,
Jaeho Yu, Seonggil Kim, Jinseop Kim
E-ISSN: 2224-2902
177
Volume 21, 2024