Ergonomics

ISSN: 0014-0139 (Print) 1366-5847 (Online) Journal homepage: http://www.tandfonline.com/loi/terg20

Effects of load carriage on heart rate, blood

pressure and energy expenditure in children
Youlian Hong , Jing Xian Li , Aaron Shun Ki Wong & Paul D. Robinson
To cite this article: Youlian Hong , Jing Xian Li , Aaron Shun Ki Wong & Paul D. Robinson (2000)
Effects of load carriage on heart rate, blood pressure and energy expenditure in children,
Ergonomics, 43:6, 717-727, DOI: 10.1080/001401300404698
To link to this article: http://dx.doi.org/10.1080/001401300404698

Published online: 10 Nov 2010.

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E RG ONOM ICS, 2000,

VOL .

43,

N O.

6, 717727

E ects of load carriage on heart rate, blood pressure and

energy expenditure in children
Y OULIAN H ONG * , J IN G X IAN L I , A AR ON SH U N K I W ONG and P AUL D . R OBINSON
D epartment of Sports Science & Physical Education, The Chinese U niversity of
H ong K ong, Shatin, N ew Territories, Hong K ong

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D epartment of Physical Education and Sports Studies, U niversity College

Worcester, Worcester, U K
Keywords: Load carriage; Children; Heart rate; Blood pressure; Energy
expenditure.
F ifteen male primary school children, aged 10 years, were selected to carry school
bags of 10, 15 and 20% of their own body weights,
where 0% body weight was
.
used as a control. M aximum oxygen uptake (V O 2 max) tests were conducted on a
motorized treadmill using a continuous incremental protocol. D uring the load
carrying test, subjects walked on a treadmill at 1.1 m s 1 for 20 min at each load
condition. Blood pressures were measured before, immediately
following, and at 3
.
and 5 min after every trial. H eart rate and expired V O 2 were recorded before,
during and 5 min after walking using a cardiopulmonary function system. The
results showed a signi cant di erence in oxygen uptake, energy expenditure and
the recovery of blood pressure rise for between 10 and 20% body weight load
conditions. The carrying weight of a school bag for children could be
recommended as 10% of body weight because it was not signi cantly di erent
from 0% load in the metabolic cost.

1. Introduction
The issue of children carrying heavy school bags is of great concern to the
community of H ong K ong and other countries. According to a report of the H ong
K ong Society for Child H ealth and D evelopment (1988), including the D epartment
of Orthopaedic Surgery at the U niversity of H ong K ong and the D uchess of K ent
Children s H ospital, H ong K ong students carried school bags of approximately 20%
of their body weights, which were double the recommended weight (10% of body
weight) of school bags (M alhotra and Sen G upta 1965). In G ermany, Voll and K limt
(1977) surveyed the weight of school bags and the distance between home and school
for the schoolchildren of Year 1 to Year 4. The relative weight of school bags varied
from one-ninth (11.1% ) to one-seventh (14.3% ) of body weight, and the travelling
time between home and school averaged 28.5 min. It was suggested that the weight
of the school bags should not exceed the optimal weight of about 10% of the body
weight, and the upper limit of the weight of the school bag should be one-eighth
(12.5% ) of the body weight. Similar results were also reported by Sander (1979) who
found that students commonly carried school bags of more than 10% of their body

*Author for correspondence. e-mail: youlianhong@cuhk.edu.hk

Ergonomics ISSN 0014-013 9 print/ISSN 1366-584 7 online 2000 Taylor & Francis Ltd
http://www.tandf.co.uk/ journals

Y . Hong et al.

718

weight, with the heaviest one reaching 18.2% of the body weight in G erman
schoolchildren of Year 1 to Year 4.
M alhotra and Sen G upta (1965) examined the physiological responses in children
to di erent ways of carrying school bags. Six schoolboys aged between 9 and 15
years were recruited as subjects. They walked at a speed of 2.5 m.p.h., which was
approximately 1.1 m s 1 and carried school bags weighing 6 lbs in four di erent
positions, i.e. rucksack on back, lower back, across shoulder, and in the hand.
R esults indicated that rucksack carrying induced minimal rises in the metabolic cost,
whereas the hand carrying induced maximal values. They also recommended 10%
body weight as the carrying weight of school bags for children. Pascoe et al. (1997)
determined the kinematics impact of school bag weight on gait cycle and posture of
youths aged between 11 and 13 years, in four di erent conditions: without bag, one
strap backpack, two strap backpack and one strap athletic bag. The bags were
loaded with 17% of the subjects mean body weight. Two-dimensional video analysis
showed that the one strap backpack promoted lateral spinal bending and shoulder
elevation, whereas the one strap athletics bag promoted greater angular motion of
head and trunk as compared to the two strap backpack book bag. Carrying the
backpack promoted signi cant forward lean of the head and trunk compared to
carrying the athletics bag or for children without a bag. As a result of the load
carried, stride length was decreased and stride frequency was increased. Wong and
H ong (1997) studied the walking pattern of children carrying varying loads. In this
study, 10 schoolboys aged 12 years walked on a treadmill at a speed of 1.1 m s 1 for
15 min under four di erent conditions, i.e. carrying 0% (without backpack), 10% ,
15% and 20% body weight backpacks. The load carriage induced a steady state
heart rate, which was approximately 50 60% of the individual maximal heart rate.
The two-dimensional video analysis showed that carrying a backpack of 20% of
body weight resulted in a signi cant increase in forward lean of the trunk and a
signi cant decrease in single leg support time when compared with a 0% body weight
load condition.
Information about the physiological stress, in terms of cardiovascular and
metabolic responses, induced by carrying di erent weights of bags in children is still
very limited. The purpose of this paper was to di erentiate the physiological e ects
of carrying di erent weights on children by simultaneous measurement of expired
air, heart rate and blood pressure. It was hoped that the ndings of this paper would
help to produce guidelines on approved school bag weight.

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2. Method
A survey of body height and weight was made for all students aged 10 years in a local
primary school. The Body M ass Index (BM I), which is a relatively good indicator of
total body composition and is related to health outcomes (American College of
Sports M edicine 1995), was then calculated for each student. The 15 students with
the most representative BMI for this group were recruited to serve as subjects in this
investigation. Before the load carrying testing was implemented, the subjects and
their parents were informed about the purpose, procedures and applications of the
study and parental consent was obtained from all concerned. This study was
approved by the Clinical R esearch Ethics Committee at the Chinese U niversity of
H ong K ong.
The subjects had a mean body weight of 33.536 2.64 kg and a mean body height
of 141.86 6 3.77 cm. Each subject participated in four trials: walking on a treadmill

Effects of load carriage in children

719

without load (0% of body weight) and with a school bag of 10, 15 and 20% of their
body weight. Subjects were asked to walk on a treadmill for 20 min at a speed of
1.1 m s 1 , a comfortable speed of walking for children (M alhotra and Sen G upta
1965, Wong and H ong 1997), with school bags carried on the mid-back region
(M alhotra and Sen G upta 1965). F or each subject, the di erent loads carried were
randomly assigned on each of four di erent testing days.
.
The maximum oxygen uptake V O 2 max in each subject was measured 1
.
week before the rst trial. The V O 2 max was used to calculate the relative
percentage of maximum capacity for an individual working with the various
.
loads. The V O 2 max tests were conducted by walking on the treadmill using a
continuous incremental protocol until the children were exhausted. The
.
modi ed Balke protocol for V O 2 max testing of children (American College
of Sports M edicine 1995) was used in this investigation. Initially the children
were habituated to the general environment and the technique of using the
treadmill. Subjects warmed up for 3 min at a speed of 6 km h 1 , then walked
at. 6 km h 1 with a 2% increase in gradient every 3 min beginning at 6% . The
V O 2 max was the maximal index measured when the subjects could no longer
continue and their heart rate was 200 beat per minute or above. The mean and
.
standard deviation of the V O 2 max of the subjects in this study was
44.03 6 4.52 ml kg 1 min 1 .
H eart rate was continuously monitored and recorded automatically throughout
and until 5 min after the walking tests using a cardiopulmonary function system
(Oxycon Champion, Yeager, G ermany). The expired air was collected by mask
connected to the cardiopulmonary function system and also continuously analysed
.
automatically to provide oxygen consumption (V O 2 , ml kg 1 min 1 and
ml min 1 ) and respiratory quotient (R Q). When beginning the measurements,
subjects were asked to stand for a few minutes until the heart rate reached a steady
.
state. The heart rate and V O 2 recorded at this state were used as a baseline.
Subjects then began the walking trial and, although all measurements were
continuously monitored and averaged every 30 s, only the data at each 5-min
interval of the 20 min walking period and 3 and 5 min after walking were used for
analysis. Energy expenditure during walking
. and at 3 and 5 min after walking was
then calculated according to the absolute V O 2 (l min 1 ), the R Q and the formula
by Weir (1949). The energy expenditure is expressed in kilocalorie per minute
.
(Cal min 1 ). The relative working intensity was calculated as the rate of V O 2 to
.
.
.
V O 2 max (% V O 2 max). In this way, the energy expenditure, V O 2 and relative
working intensity over time and under each weight carried was obtained. Blood
pressure was measured before walking, immediately after and at 3 and 5 min after
every trial.
D escriptive statistical analysis was performed on all measurements and this was
followed by two-way analysis of variance (AN OVA) to test for signi cance
di erences. If a signi cant F value was found, critical di erences were analysed by
Sche eprocedure to determine the signi cant mean di erences. The 0.05 probability
level was used for all tests as the criterion value when determining the presence or
absence of statistically signi cant results.

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3. Results
The mean and standard deviation of the physiological measurements are listed in
tables 1 and 2.

Y . Hong et al.

720
Table 1.

Mean and standard deviation of heart rate, oxygen uptake, working intensity and
energy expenditure under di erent loads.
Time (min)
Load
(% BW)

Variables
H eart rate
(beats min

0
)
10

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15
20
.
V O2
(ml kg

min

0
)
10
15
20

Working
intensity
.
(% V O 2 max)

0
10
15
20

Energy
expenditure (Cal)

0
10
15
20

10

15

20

23*

25

92.33
(8.54)
93.33
(7.11)
94.00
(6.91)
93.33
(7.10)

116.73
(10.23)
118.80
(9.86)
118.33
(10.39)
119.60
(9.59)

119.93
(11.52)
121.27
(11.35)
122.67
(11.86)
123.07
(11.37)

120.73
(11.37)
123.93
(11.06)
124.80
(12.01)
124.20
(11.21)

120.80
(11.83)
124.07
(12.42)
125.13
(12.50)
125.00
(11.74)

103.47
(13.18)
107.27
(13.51)
104.60
(11.29)
101.67
(11.36)

97.13
(9.91)
100.07
(8.53)
101.93
(11.25)
98.07
(9.68)

5.02
(0.89)
4.99
(0.53)
5.25
(0.86)
5.44
(0.87)

17.05
(1.35)
17.35
(1.24)
17.69
(1.43)
19.11
(1.47)

17.63
(1.20)
18.08
(1.34)
18.51
(1.29)
19.61
(1.39)

17.35
(1.22)
17.81
(1.13)
18.19
(1.14)
19.41
(1.29)

17.23
(1.23)
17.67
(1.23)
18.15
(1.12)
19.30
(1.23)

5.42
(0.59)
5.90
(0.55)
6.49
(0.61)
6.87
(0.80)

4.86
(0.61)
5.12
(0.51)
5.32
(0.59)
5.55
(0.83)

11.43
(1.96)
11.33
(1.33)
11.39
(3.32)
12.43
(2.08)

38.86
(4.47)
39.75
(4.46)
40.56
(5.10)
43.76
(4.96)

40.37
(4.27)
41.38
(4.30)
42.44
(5.15)
44.87
(4.69)

39.65
(3.97)
40.76
(4.08)
41.73
(4.67)
44.42
(4.55)

40.40
(2.64)
40.41
(3.89)
41.57
(4.45)
44.11
(4.20)

12.38
(1.53)
13.49
(1.57)
14.84
(1.69)
15.69
(2.06)

11.12
(1.67)
11.67
(1.13)
12.29
(1.88)
12.69
(2.01)

0.82
(0.12)
0.82
(0.07)
0.87
(0.10)
0.83
(0.23)

2.80
(0.29)
2.88
(0.29)
2.93
(0.29)
3.13
(0.35)

2.92
(0.32)
3.01
(0.27)
3.08
(0.27)
3.26
(0.32)

2.87
(0.25)
2.97
(0.27)
3.04
(0.23)
3.23
(0.32)

2.86
(0.28)
2.95
(0.23)
3.00
(0.27)
3.23
(0.29)

0.89
(0.14)
0.98
(0.11)
1.09
(0.12)
1.17
(0.13)

0.81
(0.14)
0.84
(0.11)
0.91
(0.11)
0.92
(0.13)

*3-min recovery.
5-min recovery.

The e ect of load carriage on heart rate during the 20 min of walking and until
5 min after walking is presented in gure 1. Among all load conditions, heart rate
increased signi cantly in the rst 5 min of walking (p < 0.05, Sche e
), and then
gradually increased over time during walking. After 3 min of recovery, heart rate fell
to a level approximate to the baseline. There was no signi cant di erence in heart
rate among di erent loads carried (0, 10, 15 and 20% body weight), F (3,
56) = 0.128, p > 0.05.
The e ect of load carriage on systolic and diastolic blood pressure is illustrated in
gures 2 and 3, respectively. Walking for 20 min signi cantly increased the systolic
blood pressure at all work loads (p < 0.05, Sche e
). A signi cant increase in diastolic
blood pressure measured after 20 min of walking was only found at the load
conditions of 15 and 20% of body weight (p < 0.05, Sche e
). The recovery in blood

Effects of load carriage in children

Table 2.

721

M ean and standard deviation of blood pressure under di erent loads.
Time (min)
Load
(% BW)

Variables
Systolic pressure
(mmHg)

0
10
15

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20
Diastolic pressure
(mmHg)

0
10
15
20

20

23*

25

101.00
(6.51)
99.27
(8.01)
100.73
(10.07)
103.53
(5.91)

112.97
(9.40)
114.33
(8.48)
120.67
(8.77)
122.00
(7.38)

105.47
(8.42)
104.53
(8.28)
106.40
(8.06)
109.47
(7.85)

101.73
(7.07)
102.27
(7.73)
105.73
(7.78)
108.10
(6.24)

69.40
(6.24)
69.80
(4.52)
68.93
(6.05)
70.73
(8.85)

73.80
(4.57)
73.13
(5.32)
76.80
(6.54)
77.53
(7.34)

68.87
(5.57)
71.93
(3.63)
73.13
(6.22)
74.73
(4.61)

70.53
(6.10)
71.67
(6.04)
73.13
(6.40)
74.20
(5.31)

*3-min recovery.
5-min recovery.

F igure 1. The e ects of load carriage on heart rate.

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722

Y . Hong et al.

F igure 2. The e ects of load carriage on systolic blood pressure.

pressure showed signi cant di erences among di erent loads. In carrying loads of 0
and 10% body weight, after 3 min of recovery the systolic blood pressure fell to the
level recorded before walking. H owever, even after 5 min of recovery the systolic
blood pressure in carrying loads of 15 and 20% of body weight were still higher than
that recorded before walking (p < 0.05, Sche e
). Comparing the measurements
among di erent loads, signi cant di erences in systolic and diastolic blood pressure
were found for between 0 and 20% loads of body weight (p < 0.05, Sche e
). There
was no signi cant di erence in the alteration of blood pressure among the loads of 0,
10 and 15% body weight (p > 0.05, Sche e
).
.
The e ect of load carriage on V O 2 during walking and until the fth
minute after walking is presented in gure 4. Analysis showed
that the rst
.
5 min of walking yielded a highly signi cant increase in V O 2 for each load
.
carried, F (3, 56) = 6.586, p < 0.01, after which the V O 2 increased gradually
with no signi cant di erences during the walking period. When comparing the
demand for oxygen between the di erent load conditions, walking with a load
.
of 20% body weight elicited signi cantly higher V O 2 throughout and until
3 min after walking than the loads of 0 and 10% body weight (p < 0.05,
.
Sche e
). N o signi cant di erences in V O 2 were found among the loads of 0,
10 and 15% body weight during the walking time, but carrying the load of
.
15% body weight induced signi cantly higher V O 2 (6.49 6 0.61 ml kg 1 min 1 )
at 3 min after walking than 0% body weight (5.426 0.59 ml kg 1 min 1 ) at
.
this time (p < 0.01, Sche e
). After 5 min recovery, V O 2 fell to the baseline for
each load condition.

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Effects of load carriage in children

723

F igure 3. The e ects of load carriage on diastolic blood pressure.

The changes of relative work intensity in each load condition showed the same
.
trends as those found with V O 2 . When standing, the work intensity in carrying the
loads of 0, 10, 15 and 20% of body weight were recorded as 11.43, 11.3, 11.39 and
.
12.43% V O 2 max respectively. After 20 min of walking on a treadmill these gures
were changed to 40.46 2.6, 40.46 3.9, 41.66 4.5 and 44.16 4.2% of their maximal
aerobic power, respectively. The mean work intensity during the period of steady
state (5th to 20th minute) for each respective work load was 39.7, 40.5, 41.6 and
.
44.3% of V O 2 max. The mean work intensity during the steady state conditions
.
indicated a 4.6% V O 2 max increase in metabolism
at the 20% work load above the
.
baseline 0% , compared to only a 0.8% V O 2 max increase for the 10% load. The
results implied that an increase in load caused a di erential increase in metabolic
cost.
As would be expected, the changes of energy expenditure showed similar trends
.
as the V O 2 ( gure 5). F or each load condition, the energy expenditure signi cantly
increased (p < 0.01, Sche e
) after 5 min of walking and gradually increased
thereafter with no signi cant di erences during the walking period. The 20% body
weight work load yielded signi cantly higher (p < 0.05, Sche e
) energy expenditure
than did the 0% load during walking, whereas, no signi cant di erence was found
among 0, 10 and 15% of body weight load throughout walking. When walking for
20 min, a boundary signi cant di erence (p = 0.056, Sche e
) was found between the
loads of 10 and 20% body weight.

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724

Y . Hong et al.

F igure 4. The e ects of load carriage on oxygen uptake.

4. Discussion
The main ndings of this study were that walking for 20 min when carrying loads
equal to 15 and 20% of body weight induced longer recovery periods for blood
pressure than for the 0 and 10% body weight loads; 20% body weight load yielded
signi cantly higher metabolic cost (p < 0.05) compared to loads of 0 and 10% body
weight; and no signi cant di erence in metabolic cost was found among the loads of
0, 10 and 15% body weight.
While standing there was no signi cant di erence in heart rate with the di erent
loads. H owever, the mean heart rate increased signi cantly by 8.12 beats per minute
from a resting value of 85.13 to 93.25 beats while standing with a load. This is
comparable to the results of H olewjin (1990) with adults, who reported an increase
of 9 beats per minute for young male subjects while standing, independent from type
of support or mass of the backpack.
Walking for 5 min elicited a signi cant increase in heart rate compared to
standing for carrying each of the four loads, as would be expected. H owever, during
the next 15-min walking period heart rates did not show any di erence and the
children had reached a fairly steady exercise state at each workload. These ndings
coincided with the ndings of other studies on load carriage in children (M alhotra
and Sen G upta 1965, Wong and H ong 1997). Based on the measurements of heart

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Effects of load carriage in children

725

F igure 5. The e ects of load carriage on energy expenditure.

rate, it was evident that the cardiovascular response to load carriage was
substantially in homeostatic balance (steady state). This is consistent with the
ndings of Astrand and R odahl (1986), who found that when a t subject is
.
exercising at less than 65% of V O 2 max cardiovascular response is in a steady state
after about 5 min of exercise. In evaluating the heart rate responses of children, it
was found that walking for 20 min at 20% body weight load elicited an average
heart rate of 125 beats per minute. This gure is 30 beats per minute higher than the
baseline and accounts for about 60% of the maximum heart rate.
The trends of increasing heart rate during walking with load carriage were also
found in the study on adults. H olewijn (1990) reported that a 7% body weight load
caused a signi cant increase of 8 beats/min and a 14% body weight load caused a
further signi cant increase of 6 beats/min when subjects walked 20 min on the
treadmill at a speed of 1.33 m s 1 ; however, there was no signi cant di erence in
heart rate between the loads selected.
Although measurements of blood pressure immediately after walking did not
show any signi cant di erence among the four carrying conditions, a rise of systolic
blood pressure by a mean of 12 mmHg for 0% body weight load and a mean of
19 mmH g for 20% body weight was found. Likewise the di erent e ects of carrying
di erent loads on the cardiovascular system were observed from the recovery of
blood pressure. Carrying loads equal to 15 and 20% of body weight required a
longer time for blood pressure to return to the baseline. Systolic blood pressure
increases in direct proportion to increases in exercise intensity (R owell 1986).
Therefore, the changes of blood pressure in this study indicated that the loads of 15

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726

Y . Hong et al.

and 20% body weight produce a relatively greater extra stress on the cardiovascular
system than lighter loads.
In the present study, subjects showed a signi cant di erence in the metabolic
cost in terms of oxygen uptake and energy expenditure between the loads of 10 and
20% body weight. This indicated that subjects performed di erently and the
metabolic requirement varied between these two load conditions. It was clear that
subjects had to work harder to carry the school bags of 20% body weight. The
.
relative work intensity (% V O 2 max) in 20% body weight load condition was
signi cantly greater than that in 0% body weight load condition. The increase in
metabolic cost probably resulted from more muscles being involved in working,
not only large but also smaller muscle groups (Berger 1982: 188). The increase of
load forced the subjects to lean forward (Wong and H ong 1997) in order to bring
the centre of gravity back over the base of support. This forward exion would
cause hamstring, semispinalis, tibialis anterior, vastus lateralis, erector spinae and
trapezius muscles to work harder to support the movement (Cook and N eumann
1987). As the intensity became higher, subjects recruited additional motor units
and muscle groups and altered their gait to carry the load (Pascoe et al. 1997).
M artin and N elson (1986) reported altered locomotion biomechanics, which
resulted in higher actual power output to carry a given load. M oreover, the
inclined body position and the altered locomotion biomechanics on a daily basis
would increase the stresses on the back and leg muscles of the subjects. F or
subjects who were 10 years old, these stresses might be harmful and in uence their
normal musculoskeletal developmental growth.
M alhotra and Sen G upta (1965) recommended that the weight usually carried by
students is not likely to exceed 10 12% of the body weight because in their study
nobody was observed to be bending forwards. This recommendation was then widely
accepted as a criterion for students carrying school bags (Voll and K limt 1977,
Sander 1979). H owever, experimental evidence supporting the comment of M alhotra
and Sen G upta (1965) is still limited. The present study has demonstrated that there
is more physiological strain in terms of heart rate, blood pressure and metabolic cost
in carrying 20% than in carrying 10% body weight load. This was primarily caused
by the greater intensity of workload and probably the altered locomotion
biomechanics. F rom the above evidence it seems clear that a load of 10% of body
weight should be recommended as the carrying weight of school bags for children
since it causes the least disturbance of metabolic processes.
Acknowledgement
This study was supported by a direct grant for research from The Chinese U niversity
of H ong K ong.
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