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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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and the upper limit of the weight of the school bag should be one-eighth (12. In G ermany.1 m s 1 for 20 min at each load condition. 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. U K Keywords: Load carriage. It was suggested that the weight of the school bags should not exceed the optimal weight of about 10% of the body weight. subjects walked on a treadmill at 1. Hong K ong Downloaded by [Indian Institute of Technology Guwahati] at 00:54 15 May 2016 ³ D epartment of Physical Education and Sports Studies. J IN G X IAN L I ² . Children. D uring the load carrying test. Worcester. N O.tandf. and 5 min after every trial. e-mail: youlianhong@cuhk. 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. U niversity College Worcester. Energy expenditure.edu. Shatin. F ifteen male primary school children. 6. which were double the recommended weight (10% of body weight) of school bags (M alhotra and Sen G upta 1965). H ong K ong students carried school bags of approximately 20% of their body weights.5% ) of the body weight. blood pressure and energy expenditure in children Y OULIAN H ONG *² . aged 10 years. Heart rate. 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. 15 and 20% of their own body weights. R OBINSON ³ ² D epartment of Sports Science & Physical Education.uk/ journals . 2000. The results showed a signi® cant di erence in oxygen uptake. According to a report of the H ong K ong Society for Child H ealth and D evelopment (1988). A AR ON SH U N K I W ONG ² and P AUL D . and the travelling time between home and school averaged 28.5 min. during and 5 min after walking using a cardiopulmonary function system. Blood pressures were measured before.hk Ergonomics ISSN 0014-013 9 print/ISSN 1366-584 7 online Ó 2000 Taylor & Francis Ltd http://www. 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. H eart rate and expired V O 2 were recorded before. Introduction The issue of children carrying heavy school bags is of great concern to the community of H ong K ong and other countries. The relative weight of school bags varied from one-ninth (11. N ew Territories.co. 43. VOL .3% ) of body weight. were selected to carry school bags of 10. where 0% body weight was . and at 3 . 717±727 E€ ects of load carriage on heart rate. energy expenditure and the recovery of blood pressure rise for between 10 and 20% body weight load conditions. used as a control. Blood pressure. The Chinese U niversity of H ong K ong. immediately following.E RG ONOM ICS.1% ) to one-seventh (14. M aximum oxygen uptake (V O 2 max) tests were conducted on a motorized treadmill using a continuous incremental protocol. Ð 1.

This study was approved by the Clinical R esearch Ethics Committee at the Chinese U niversity of H ong K ong. which is a relatively good indicator of total body composition and is related to health outcomes (American College of Sports M edicine 1995). They walked at a speed of 2. The 15 students with the most representative BMI for this group were recruited to serve as subjects in this investigation. Information about the physiological stress. induced by carrying di erent weights of bags in children is still very limited. stride length was decreased and stride frequency was increased.1 m s 1 for 15 min under four di erent conditions. Method A survey of body height and weight was made for all students aged 10 years in a local primary school. heart rate and blood pressure. Hong et al. The Body M ass Index (BM I). They also recommended 10% body weight as the carrying weight of school bags for children. i. in four di erent conditions: without bag. rucksack on back. which was approximately 50 ±60% of the individual maximal heart rate. 718 weight. was then calculated for each student.p. with the heaviest one reaching 18.Y .h.86 6 3. Two-dimensional video analysis showed that the one strap backpack promoted lateral spinal bending and shoulder elevation. The subjects had a mean body weight of 33. carrying 0% (without backpack)..2% of the body weight in G erman schoolchildren of Year 1 to Year 4.536 2. It was hoped that the ® ndings of this paper would help to produce guidelines on approved school bag weight. R esults indicated that rucksack carrying induced minimal rises in the metabolic cost. 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. and in the hand. As a result of the load carried. The load carriage induced a steady state heart rate. Before the load carrying testing was implemented.5 m. whereas the one strap athletics bag promoted greater angular motion of head and trunk as compared to the two strap backpack book bag.e. Each subject participated in four trials: walking on a treadmill . The bags were loaded with 17% of the subject’s mean body weight. whereas the hand carrying induced maximal values. in terms of cardiovascular and metabolic responses. which was approximately 1. 10% .e. (1997) determined the kinematics impact of school bag weight on gait cycle and posture of youths aged between 11 and 13 years. across shoulder. Wong and H ong (1997) studied the walking pattern of children carrying varying loads. two strap backpack and one strap athletic bag. lower back. one strap backpack. 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. 10 schoolboys aged 12 years walked on a treadmill at a speed of 1. the subjects and their parents were informed about the purpose. Downloaded by [Indian Institute of Technology Guwahati] at 00:54 15 May 2016 Ð Ð 2. i. Pascoe et al. In this study. M alhotra and Sen G upta (1965) examined the physiological responses in children to di erent ways of carrying school bags. procedures and applications of the study and parental consent was obtained from all concerned.77 cm.64 kg and a mean body height of 141. Six schoolboys aged between 9 and 15 years were recruited as subjects. 15% and 20% body weight backpacks. 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.1 m s 1 and carried school bags weighing 6 lbs in four di erent positions.

Results The mean and standard deviation of the physiological measurements are listed in tables 1 and 2. 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. The . (Cal min 1 ).Effects of load carriage in children 719 without load (0% of body weight) and with a school bag of 10. When beginning the measurements. subjects were asked to stand for a few minutes until the heart rate reached a steady . 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. Subjects were asked to walk on a treadmill for 20 min at a speed of 1. then walked at. standard deviation of the V O 2 max of the subjects in this study was 44. The maximum oxygen uptake V O 2 max in each subject was measured 1 . the di erent loads carried were randomly assigned on each of four di erent testing days. V O 2 and relative working intensity over time and under each weight carried was obtained. F or each subject. In this way. The V O 2 max tests were conducted by walking on the treadmill using a continuous incremental protocol until the children were exhausted. The V O 2 max was used to calculate the relative percentage of maximum capacity for an individual working with the various . the R Q and the formula by Weir (1949). The 0. . 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. Subjects warmed up for 3 min at a speed of 6 km h 1 . Blood pressure was measured before walking. the energy expenditure.05 probability level was used for all tests as the criterion value when determining the presence or absence of statistically signi® cant results.1 m s 1 . The mean and . .03 6 4. critical di erences were analysed by Sche eÂprocedure to determine the signi® cant mean di erences. Subjects then began the walking trial and. automatically to provide oxygen consumption (V O 2 . 6 km h 1 with a 2% increase in gradient every 3 min beginning at 6% . and at 3 and 5 min after walking was then calculated according to the absolute V O 2 (l min 1 ). 15 and 20% of their body weight. ml kg 1 min 1 and ml min 1 ) and respiratory quotient (R Q). The energy expenditure is expressed in kilocalorie per minute . 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.52 ml kg 1 min 1 . modi® ed Balke protocol for V O 2 max testing of children (American College of Sports M edicine 1995) was used in this investigation. Yeager. V O 2 max (% V O 2 max). week before the ® rst trial. . The relative working intensity was calculated as the rate of V O 2 to . G ermany). Initially the children were habituated to the general environment and the technique of using the treadmill. The heart rate and V O 2 recorded at this state were used as a baseline. Wong and H ong 1997). with school bags carried on the mid-back region (M alhotra and Sen G upta 1965). Energy expenditure during walking . The expired air was collected by mask connected to the cardiopulmonary function system and also continuously analysed . immediately after and at 3 and 5 min after every trial. . although all measurements were continuously monitored and averaged every 30 s. Downloaded by [Indian Institute of Technology Guwahati] at 00:54 15 May 2016 Ð Ð Ð Ð Ð Ð Ð Ð Ð Ð 3. a comfortable speed of walking for children (M alhotra and Sen G upta 1965. loads. state.

42 (4.64) 40.46) 40.33 (10. V O2 (ml kg Ð 1 min Ð 1 0 ) 10 15 20 Working intensity .35) 122.75 (4.61) 5.05.34) 18.68) 5.87 (0.35) 2.41 (3.93 (11.49 (0.13 (12.33 (7.23) 118.00 (6.17 (0.67 (11.29) 3.12) 1.57 (4.44 (5.23 (0.89 (0.51) 104.92 (0.29) 2.23) 3.97 (0.67 (1.33) 11.98 (0. Among all load conditions.29) 17.86 (4.92 (0.23) 2. 10. respectively. oxygen uptake. F (3.23 (1.60 (9.69 (2.95 (0.35 (1. heart rate increased signi® cantly in the ® rst 5 min of walking (p < 0.27 (13.56 (5.87 (4.07 (8.73 (11.11 (4.08) 41.18) 107.80) 4.12) 19.87 (0.15) 44.39) 17.28) 2.07 (9.23) 5.06) 11.87 (0.65 (3. The e ect of load carriage on systolic and diastolic blood pressure is illustrated in ® gures 2 and 3.27) 3.25) 2.128.20 (11.11 (1.49 (1.12 (1.67) 44.43 (1.69) 39.96) 40.29) 0.08 (1.73 (4.33 (7.47) 17.09 (0.43 (2.11) 0. and then gradually increased over time during walking. ² 5-min recovery. After 3 min of recovery.63 (1.88) 12.21) 120.59) 5. 15 and 20% body weight).11) 0.69 (1.25) 98.33 (1.14) 0. Hong et al.91 (0.89) 4.82 (0. heart rate fell to a level approximate to the baseline.99 (0. Time (min) Load (% BW) Variables H eart rate (beats min Ð 1 0 ) 10 Downloaded by [Indian Institute of Technology Guwahati] at 00:54 15 May 2016 15 20 . Sche e ).05.35 (1.27) 3.06) 124.80 (9. Sche e ).32) 12.00 (0.12 (0.32) 2.13) 0.22) 17.24) 17.11) 1.61 (1.13 (0.80 (11.27) 41.32 (0.05 (1.23 (0.73 (10.38 (1.14) 19.26 (0.13) 12.13) 18.44 (0.90 (0.10) 0.91) 93.05.86 (0.32) 2.67 (11.39) 119.23) 3.08 (0.32) 3. (% V O 2 max) 0 10 15 20 Energy expenditure (Cal) 0 10 15 20 0 5 10 15 20 23* 25² 92.53) 101.10) 43.20) 12.97) 40.14) 0.04 (0.47 (13.07) 0.19 (1.45) 44. 56) = 0.07 (11.05.55) 6.50) 125.13) *3-min recovery.29 (1.41 (1.29) 101.84 (1. 720 Table 1. p > 0.67 (1.30) 42.39 (3.61) 6.40 (2.60 (11.74) 103.89) 41. The recovery in blood .59) 5.93 (11.27) 3. Walking for 20 min signi® cantly increased the systolic blood pressure at all work loads (p < 0.88 (0.59) 119.35) 17.80 (12.30 (1.38 (4.54) 93.02 (0.10) 116. 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 < 0.47) 39.36) 97.20) 18.96) 11.01) 124.29) 2. There was no signi® cant di erence in heart rate among di erent loads carried (0.27) 3.23) 18.82 (0.15 (1.37) 123. Mean and standard deviation of heart rate.37 (4.53) 5.42) 125.55 (0.93 (0.12) 0.87) 17.00 (11.91) 100.37) 120.55) 40.53) 13.23) 17.11) 94.42 (0.81 (1.83) 124.84 (0.07 (12.83 (0. working intensity and energy expenditure under di erent loads.69) 15.67) 11. 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 1.81 (0.08) 38.01) 0.52) 121.93 (11.86) 118.80 (0.33 (8.76 (4.51) 5.83) 11.69 (2.43) 19.76 (4.13 (9.25 (0.27 (11.29) 19.51 (1.01 (0.86 (0.Y .86) 123.86) 5. Sche e ).57) 14.

² 5-min recovery.00 (6.40) 114.13 (6.34) 68. F igure 1.73 (10.91) 112.57) 71.80 (4.07) 103.54) 77.51) 99.53 (5.32) 76.48) 120.73 (8.61) 70.67 (8.93 (6.27 (8.73 (7.80 (4.47 (7. 721 M ean and standard deviation of blood pressure under di erent loads.38) 105.27 (7.93 (3.73 (4.73 (7.00 (7. .28) 106.52) 68. The e ects of load carriage on heart rate.01) 100.78) 108.24) 69.Effects of load carriage in children Table 2.85) 73.80 (6.53 (7.10) 71.53 (8.73) 105.53 (6.47 (8. Time (min) Load (% BW) Variables Systolic pressure (mmHg) 0 10 15 Downloaded by [Indian Institute of Technology Guwahati] at 00:54 15 May 2016 20 Diastolic pressure (mmHg) 0 10 15 20 0 20 23* 25² 101.63) 73.87 (5.06) 109.40 (6.67 (6.24) 69.05) 70.40) 74.31) *3-min recovery.13 (5.33 (8.85) 101.40 (8.20 (5.42) 104.22) 74.57) 73.77) 122.04) 73.07) 102.10 (6.13 (6.97 (9.

Hong et al. When comparing the demand for oxygen between the di erent load conditions. 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. The e ect of load carriage on V O 2 during walking and until the ® fth minute after walking is presented in ® gure 4. after 3 min of recovery the systolic blood pressure fell to the level recorded before walking. 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. N o signi® cant di erences in V O 2 were found among the loads of 0. pressure showed signi® cant di erences among di erent loads.05. . this time (p < 0. signi® cant di erences in systolic and diastolic blood pressure were found for between 0 and 20% loads of body weight (p < 0.01. There was no signi® cant di erence in the alteration of blood pressure among the loads of 0.426 0. The e ects of load carriage on systolic blood pressure. H owever. Sche e ). Sche e ). walking with a load . 10 and 15% body weight during the walking time. but carrying the load of . 10 and 15% body weight (p > 0. 15% body weight induced signi® cantly higher V O 2 (6. Ð Ð Ð Ð . V O 2 fell to the baseline for each load condition.Downloaded by [Indian Institute of Technology Guwahati] at 00:54 15 May 2016 722 Y . 5 min of walking yielded a highly signi® cant increase in V O 2 for each load . In carrying loads of 0 and 10% body weight.05.05.01. after which the V O 2 increased gradually with no signi® cant di erences during the walking period. F igure 2. p < 0.49 6 0. Comparing the measurements among di erent loads. F (3.586. Sche e ). After 5 min recovery.59 ml kg 1 min 1 ) at .05. . Analysis showed that the ® rst . 56) = 6. Sche e ).61 ml kg 1 min 1 ) at 3 min after walking than 0% body weight (5. Sche e ). carried.

11. respectively.46 2. the energy expenditure signi® cantly increased (p < 0.056. as the V O 2 (® gure 5). 44. Sche e ) was found between the loads of 10 and 20% body weight.66 4. The mean work intensity during the period of steady state (5th to 20th minute) for each respective work load was 39.8% V O 2 max increase for the 10% load.5.01. When standing. The 20% body weight work load yielded signi® cantly higher (p < 0. 11. the changes of energy expenditure showed similar trends . 15 and 20% of body weight were recorded as 11.16 4. Sche e ) energy expenditure than did the 0% load during walking. As would be expected.43. The results implied that an increase in load caused a di erential increase in metabolic cost. 40.6 and . whereas. trends as those found with V O 2 . Sche e ) after 5 min of walking and gradually increased thereafter with no signi® cant di erences during the walking period.6% V O 2 max increase in metabolism at the 20% work load above the .5 and 44. .3% of V O 2 max. 41. a boundary signi® cant di erence (p = 0. the work intensity in carrying the loads of 0. The mean work intensity during the steady state conditions .39 and .7.46 3. 40. The e ects of load carriage on diastolic blood pressure. baseline 0% . When walking for 20 min.3. compared to only a 0. 10.05. 41. no signi® cant di erence was found among 0. 12.43% V O 2 max respectively.6.9. 10 and 15% of body weight load throughout walking.2% of their maximal aerobic power. F or each load condition. indicated a 4.Downloaded by [Indian Institute of Technology Guwahati] at 00:54 15 May 2016 Effects of load carriage in children 723 F igure 3. After 20 min of walking on a treadmill these ® gures were changed to 40. The changes of relative work intensity in each load condition showed the same .

F igure 4. independent from type of support or mass of the backpack. 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. who reported an increase of 9 beats per minute for young male subjects while standing. These ® ndings coincided with the ® ndings of other studies on load carriage in children (M alhotra and Sen G upta 1965. Based on the measurements of heart . 4. 10 and 15% body weight. Walking for 5 min elicited a signi® cant increase in heart rate compared to standing for carrying each of the four loads.Downloaded by [Indian Institute of Technology Guwahati] at 00:54 15 May 2016 724 Y . 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.13 to 93. the mean heart rate increased signi® cantly by 8. and no signi® cant di erence in metabolic cost was found among the loads of 0.12 beats per minute from a resting value of 85.25 beats while standing with a load.05) compared to loads of 0 and 10% body weight. Hong et al. While standing there was no signi® cant di erence in heart rate with the di erent loads. H owever. 20% body weight load yielded signi® cantly higher metabolic cost (p < 0. This is comparable to the results of H olewjin (1990) with adults. as would be expected. Wong and H ong 1997). The e ects of load carriage on oxygen uptake. H owever.

however. Although measurements of blood pressure immediately after walking did not show any signi® cant di erence among the four carrying conditions. rate. The trends of increasing heart rate during walking with load carriage were also found in the study on adults. 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. exercising at less than 65% of V O 2 max cardiovascular response is in a steady state after about 5 min of exercise. it was evident that the cardiovascular response to load carriage was substantially in homeostatic balance (steady state). This ® gure is 30 beats per minute higher than the baseline and accounts for about 60% of the maximum heart rate. In evaluating the heart rate responses of children. Systolic blood pressure increases in direct proportion to increases in exercise intensity (R owell 1986).33 m s 1 . This is consistent with the ® ndings of AÊstrand and R odahl (1986). the changes of blood pressure in this study indicated that the loads of 15 Ð . Likewise the di erent e ects of carrying di erent loads on the cardiovascular system were observed from the recovery of blood pressure. there was no signi® cant di erence in heart rate between the loads selected. Therefore. who found that when a ® t subject is .Downloaded by [Indian Institute of Technology Guwahati] at 00:54 15 May 2016 Effects of load carriage in children 725 F igure 5. Carrying loads equal to 15 and 20% of body weight required a longer time for blood pressure to return to the baseline. it was found that walking for 20 min at 20% body weight load elicited an average heart rate of 125 beats per minute. The e ects of load carriage on energy expenditure. 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.

Sander 1979). H owever. O. Ergonomics. erector spinae and trapezius muscles to work harder to support the movement (Cook and N eumann 1987). PA: Lea & F ebiger). and R O DA H L . semispinalis. Guidelines for Exercise T esting and Prescription. References AÊST RA ND . 1982. 61. It was clear that subjects had to work harder to carry the school bags of 20% body weight. Acknowledgement This study was supported by a direct grant for research from The Chinese U niversity of H ong K ong. Physiological strain due to load carrying. A. vastus lateralis. tibialis anterior. . 1986. 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. not only large but also smaller muscle groups (Berger 1982: 188). 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. Applied Exercise Physiology (Philadelphia. and 20% body weight produce a relatively greater extra stress on the cardiovascular system than lighter loads. 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. This recommendation was then widely accepted as a criterion for students carrying school bags (Voll and K limt 1977. subjects recruited additional motor units and muscle groups and altered their gait to carry the load (Pascoe et al. 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. C O O K . Hong et al. A. 3rd edn (New York: M cG raw-H ill). The present study has demonstrated that there is more physiological strain in terms of heart rate. 5th edn (Baltimore: Williams & Wilkins). As the intensity became higher. This forward ¯ exion would cause hamstring. and N EU M A N N . M . 1997).Downloaded by [Indian Institute of Technology Guwahati] at 00:54 15 May 2016 726 Y . R . The . This indicated that subjects performed di erently and the metabolic requirement varied between these two load conditions. A M ER IC A N C O LL E GE O F SP O RT S M ED IC I NE 1995. The increase in metabolic cost probably resulted from more muscles being involved in working. This was primarily caused by the greater intensity of workload and probably the altered locomotion biomechanics. BE R G E R . K. these stresses might be harmful and in¯ uence their normal musculoskeletal developmental growth. D . F or subjects who were 10 years old. 308 ±311.. M . blood pressure and metabolic cost in carrying 20% than in carrying 10% body weight load. experimental evidence supporting the comment of M alhotra and Sen G upta (1965) is still limited. 30. M oreover. 1990. 1987. P. The e ects of load placement on the activity of the low back muscles during load carrying by men and women. which resulted in higher actual power output to carry a given load. T. M artin and N elson (1986) reported altered locomotion biomechanics. H O L EW I JN . 1413 ±1423. 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. T extbook of W ork Physiology: Physiological Bases of Exercise. 237 ±245. In the present study. European Journal of Applied Physiology. 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 D uchess of K ent Children’s H ospital). P A SC OE . C. Strain in children caused by carrying school bags.. 29. Carrying of school bags by children. D. F. M . 1949. 1979. W O NG . 1977. O€ entliche Gesundheitswesen. D . 251 ±253. M . 39. K . B. Y. University of Hong K ong. 55 ±60. 40. E. Human Circulation Regulation During Physical Stress (New York: Oxford U niversity Press). and K I M . 1 ±9. Medicine and Science in Sports and Exercise. T he weight of school bags and its relation to spinal deformity (Hong Kong: Hong Kong Society for Child H ealth and D evelopment. A. 1997. S. O€ entliche Gesundheitswesen. 1997. K . E. D E V. 1986. VO LL . P. M A RT IN . 85. J. T. Y. D. The D epartment of Orthopaedic Surgery. SH IN .. 631 ±641. J. Walking pattern analysis of primary school children during load carriages on treadmill. 1965. N ew methods of calculating metabolic rate with special references to protein metabolism. 29. The e ect of carried loads on the walking patterns of men and women. 41. J. L. and SEN G U P TA. In¯ uence of carrying book bags on gait cycle and posture of youths. P A SC O E. Ergonomics. R O WE L L. 8. Journal of Physiology. M .. W A N G . and H O NG . Ergonomics. 369 ±378. 1988. . R. M A LH O T RA . H. 109. 1191 ±1202. and N EL SO N ..Downloaded by [Indian Institute of Technology Guwahati] at 00:54 15 May 2016 Effects of load carriage in children 727 H O N G K O N G SO CI E TY F O R C H I LD H E A LT H and D E VEL O P MEN T . Ergonomics. S. C. Weight of school bags in a F reibury elementary school: recommendations to parents and teachers. D. and K L I MT . W EI R . 1986. SA N D E R .