Journal of Back and Musculoskeletal Rehabilitation 29 (2016) 109–115 109

DOI 10.3233/BMR-150605
IOS Press

Effect of single and double backpack strap

loading on gait and perceived exertion of
young adults
Ukachukwu Okoroafor Abaraogu∗, Wisdom Onyedikachi Ugwa, Ezinne Onwuka and
Ebubechukwu Orji
Department of Medical Rehabilitation, Faculty of Health Science and Technology, College of Medicine, University
of Nigeria, Enugu Campus, Enugu, Nigeria

Abstract.
BACKGROUND/AIM: Backpack effect posture, walking and physiological costs but there is dearth of literature on effects of
backpack strap (1 versus 2 straps) on gait and perceived exertion among young adults. We determined the influence of type of
backpack shoulder strap on gait parameters and perceived exertion of young adults in a free-living normal walking speed.
METHODS: Twenty-five young adults with a mean age of 22 years underwent a self-selected normal speed walking for six
minutes each under 3 testing conditions: without a backpack; with 1 strap; and with 2 straps. Selected gait parameters and
perceived exertion were assessed.
RESULTS: There were no significant difference in stride length, stride time, step length, step time, gait speed, and cadence
among the three walking conditions. However, perceived exertions were significantly higher when the backpack was carried with
15% irrespective of 1 strap or 2 straps.
CONCLUSION: Momentary carriage of a backpack either on 1 strap or 2 straps does not appear to influence gait phases.
However, this short bout of normal walking appear to increase perceived exertion in young adults irrespective of whether the
backpack is wore on single or double shoulder strap.

Keywords: Backpack load, backpack strap, young adults, perceived exertion, human gait

1. Introduction
People use bags to carry various items they need in
daily life. Young adult students use backpacks, which
are usually carried over their shoulders [1,2]. Overly
heavy bags and inadequate carrying methods may dis-
tribute the weight inappropriately causing abnormal
posture [3]. From a biomechanical perspective, abnor-
mal posture begets abnormal gait pattern. However, as
people habitually carry backpacks, they tend to neglect
potential problems that could be associated to back-
∗ Corresponding author: Ukachukwu Okoroafor Abaraogu, De-
partment of Medical Rehabilitation, College of Medicine, Univer-
sity of Nigeria, Enugu Campus, Enugu, Nigeria. E-mail: ukachukwu.
abaraogu@unn.edu.ng, uabaraogu@yahoo.com.
packs and how they are carried on the body. Succinctly
put, as movement of backpack and walking are cor-
related, the importance of possible untoward effect of
backpack carriage and method on walking cannot be
over emphasized.
Several studies have reported alteration in gait pa-
rameters associated with backpack use but these inves-
tigations were largely among children and adolescents.
Cottalorda et al. found that although there were no dif-
ferences in gait parameters among children during sin-
gle strap shoulder loading compared to double strap,
the gait parameters difered when wearing a backpack
compared to walking without a backpack [4]. In con-
trast, a study among adolescents, found out that stride
frequency increased while stride length decreased and
concluded that carrying back pack on 1 shoulder sig-

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110 U.O. Abaraogu et al. / Effect of single and double backpack strap loading on gait and perceived exertion of young adults
nificantly alter gait parameters among adolescents and
children. Additionally, a study by Cho and colleagues
reported decrease in speed and cadence, and increase in
double support time when walking with loaded back-
pack [5].
From the above reports, one common fact that pre-
cipitates is that the influences of backpacks weight
and method of carrying them (single versus double) on
gait parameter maybe mediated by age. Lamentably, all
studies on backpack shoulder strap type and influences
on gait parameter has been largely among children and
adolescents. To our knowledge, no study has investi-
gated the effect of backpack shoulder strap on gait pa-
rameters among young adults utilizing free-living nor-
mal walking. Also variation in perceived exertion as a
result of varied backpack load and strapping options
has not been adequately studied among young adults.
This information is important given that young adults
are a significant user of backpack and constitute ma-
jor proportion of workforce and the student population
who use backpack. Therefore knowing the influences
of varied loading pattern (1 strap vs 2 straps) on gait
and perceived exertion is important for education on
healthy backpack practices.
Therefore, we aim to investigate influence of type
of backpack shoulder strap on gait parameters and per-
ceived exertion among young adults during walking.
2. Method
A convenient sample of 25 university undergraduate
age between 18 and 25 were recruited from the Univer-
sity of Nigeria Enugu Campus. There were composed
of 13 female (mean age 21.8 ± 3.1) and male (mean
age 22.1 ± 2.7 years). A prior power analysis showed
that to get a moderate to large effect size (d = 0.6),
[6] at a power of 0.8 and 0.05 level of significance, a
minimum sample size of 22 subjects will be required.
However 25 subjects were recruited to account for any
unforeseen extraneous cofounder.
To be included a participant must meet all the fol-
lowing criteria: sign a voluntary informed consent;
present a typical gait pattern [7]; be able to wear
a backpack on 1 shoulder and on 2 shoulders; and
be able to walk independently. Participants who met
any one of the following criteria were excluded from
the study: any obvious postural deviation, orthope-
dic problem including limb length discrepancy, back
pain, and any musculoskeletal or neurological problem
including, but not limited to arthritis, cerebral palsy,
and myelodysplasia. The final eligibility criterion was
passing a physical activity readiness screening, and
was done with participants completing a physical ac-
tivity readiness questionnaire.
2.1. Procedure
The research was reviewed and the protocol ap-
proved by University of Nigeria Research Ethics Com-
mittee (NHREC/05/01/2008B-FWA00002458-1RB00
002323). Individuals who consented to participate in
the study, and who met the inclusion criteria were
recruited into the study until a 25-subject pool was
reached. A plumb line was used to map the spine to
detect any obvious curvature of the spine, which ren-
ders participants ineligible. Each of the 25 participants
was tested (for the 3 conditions) the same day with
10 minute rest between each testing conditions. The
tests were done at the same time of the day between
7:30 am and 9:30 am. Three persons underwent the test
each day, and it took 9 days to complete the data col-
lection. A modified six minute walk test was implored
for this study. Instead of walking at the fastest speed
possible, velot 5 [8], as obtained in the traditional six
minute walk test [9] participants were asked to walk for
six minute under self-selected normal walking speed –
corresponding to velot 3 according to the velocity field
diagram (VFD) protocol described by Eke-Okoro [8],
as modified by Ibeneme [10].
The experiment was conducted at the gait laboratory
of the Department of Medical Rehabilitation of Uni-
versity of Nigeria. The order in which an individual
entered or finished the 3 experimental protocols (un-
loaded walking, walking with 1 strap backpack load,
walking with 2 straps backpack load) was random-
ized by individuals picking lots. By this arrangement
each person served as his/her own control. For the ran-
domization, ABC, ACB, BCA, BAC, CAB and CBA
was written on a paper of equal size and folded such
that each individual picking one paper determines how
he/she will enter and leaves the three experimental con-
ditions. For instance, a person who picks CBA would
first carry double strap and ends the experiment by
walking without carrying a backpack. Picking of lots
was done with replacement.
Weight of the subjects was obtained to the near-
est 0.1 kg to determine 15% of the body weight for
the purpose of loading the backpack. A standard ny-
lon backpack (CKN-1698 AOPAI, China) with dimen-
sions 47 × 35 × 20 was utilized. The backpack was
filled with internal frame (30 × 25 × 38 cm) of 1.0 kg
 U.O. Abaraogu et al. / Effect of single and double backpack strap loading on gait and perceived exertion of young adults 111

Table 1
Comparison the gait parameters and perceived exertion under the test condition among young adults
Variables X ± SD F p-value
GAIT PRARMETERS
Stride length (metres)
Unloaded walking 1.86 ± 0.17
1 strap walking 1.91 ± 0.24 0.47 0.627
2 straps walking 1.92 ± 0.28
Stride time (seconds)
Unloaded walking 1.22 ± 0.09
1 strap walking 1.23 ± 0.10 0.14 0.869
2 straps walking 1.24 ± 0.15
Step length (metres)
Unloaded walking 0.93 ± 0.08
1 strap walking 0.96 ± 0.12 0.515 0.600
2 strap walking 0.96 ± 0.14
Step time (seconds)
Unloaded walking 0.61 ± 0.045
1 strap walking 0.61 ± 0.052 0.164 0.849
2 strap walking 0.61 ± 0.076
Gait speed (metre/seconds)
Unloaded walking 1.54 ± 0.21
1 strap walking 1.56 ± 0.22 0.119 0.888
2 strap walking 1.56 ± 0.22
Cadence
Unloaded walking 99.04 ± 7.42
1 strap walking 99.28 ± 7.61 0.063 0.939
2 strap walking 98.24 ± 11.38
PERCEIVED EXERTION
Unloaded walking 105.44 ± 23.10
1 strap walking 153.28 ± 18.78 29.908 0.001∗
2 straps walking 138.44 ± 24.85

weight, which was adjustable for positioning the cen-
ter of gravity of the load at T7, T12, and L3. Subjects
were asked to adjust the length of the strap to have a
comfortable fit in line with a previously documented
protocol [11].
We explored 15% body weight of backpack load be-
cause this is the upper boundary for the recommended
healthy backpack load [12]. Again prevalent range of
backpack load carried by young adults in our popula-
tion falls within 15% of body weight. The protocol pro-
gressed as follows, a participant is asked to rehearse
normal walking by walking to and fro the laboratory
of dimension 30 × 15 meters. Then he/she under-
went 6 minute walking according to a pre-randomized
sequence. Each test condition (unloaded, 1 strap, 2
straps) of 6 minutes walking is followed by a 10-
minute rest before the succeeding test condition. Turns
are made by 3 curves of 2 cm apart such that each
participant self-selects the point to initiate turns with-
out altering his gait variable. For the condition dur-
ing which participants carried backpack on one shoul-
der, they were allowed to put the strap on the preferred
shoulder.
Each person was monitored throughout the testing
conditions and gait parameters were calculated ac-
cording to the methods described by previous stud-
ies [8,13] as follows: Mean Stride length, SL (meters)
was derived by distance walked (m)/number of steps
× 2. Stride time, (seconds) was calculated as 6 min-
utes divided by total number of steps multiplied by
2. Step length was calculated as total distance walked
(m)/number of steps. Step time seconds) was calcu-
lated as 6 × 60 × 60/number of steps. Gait speed
(meter/sec) was calculated as total distance walked
(m)/total time taken(s) (6 × 60 × 60). Cadence was
calculated as number of steps/6. This method of gait
parameters derivation are well validated [8,10,14,15].
The subject’s perceived exertion rate was also obtained
by having them complete the Borg scale question-
naire [16] immediately after every test condition.
2.2. Data analysis
The mean and standard deviations (SD) of the gait
parameters and perceived exertion of the participants
under unloaded condition and while carrying single
and double strapped backpacks of 15% body weight
were represented in a table. The result of the values
of gait parameters and perceived exertion under the
112 U.O. Abaraogu et al. / Effect of single and double backpack strap loading on gait and perceived exertion of young adults
Table 2
Bonferroni Post Hoc analysis of walking with unloaded, single and double back pack shoulder strap of young adults: Perceived exertion in the
three test conditions
Unloaded walking
Unloaded walking − 0.001∗
1 strap walking
2 strap walking
three test conditions were compared using One-Way
repeated measures Analysis of Variance (ANOVA) to
investigate the influence of different loading conditions
(ie unloaded condition and loaded conditions with sin-
gle and double strapped backpack) on gait phases and
perceived exertion. Bonferroni Post-Hoc criteria were
adopted for all post hoc comparisons. SPSS for win-
dows (SPSS 15.0, SPSS inc. Chicago, IL) was utilized
for all analysis. Alpha level was set at 0.05 and two-tail
test was adopted.
3. Results
Twenty-five young adults (13 male 12 females) with
mean age 22.23 ± 2.56 were involved in our present
study. The result showed that there was no significant
difference in the gait parameters for the 3 test con-
ditions. However, perceived exertion differs in the 3
test conditions as seen in Table 1. Bonferroni Post Hoc
showed a significant increase in perceived exertion as
the individuals transcend from unloaded walking to
walking carrying a backpack on a single strap as well
as in the comparison between unloaded walking versus
carrying a backpack on 2 straps (p < 0.01). There was
however no significant difference in the comparison
between single strap walking and double strap walking
as seen in Table 2.
4. Discussion
This is the first study on young adult investigat-
ing gait variations from variable backpack strap load-
ing using a free living walking test instead of sim-
ulation of community walking on a treadmill. Again
normal speed walking which are the commonly im-
plored by people carrying backpacks, and which was
utilized in this research among this population is novel.
Therefore, our study is seminal, and although may not
yet have a specific direct practice application, serves a
good foundation for future researches on mechanism
of gait alteration sequel to back pack usage. This is
important given numerous established neuromuscular
Single strap walking Double strap walking
0.001∗
− 0.066
−
pathologies associated with backpack carriage and the
need to understand safe back pack practice.
There was no significant difference in the stride
length and duration of the young adults when walk-
ing without backpack compared with walking carry-
ing backpack on 1 strap as well as walking while car-
rying backpack on 2 straps. Our findings are similar
to two previous studies among children and adoles-
cents [17,18], that assessed stride length and its dura-
tion and found no significant difference between walk-
ing without load and walking with backpack of 15%
of body weight. However, Cottalorda et al. reported
that stride length and time increased when backpack
was carried over 1 shoulder compared to walking with-
out backpack [4]. In contrast, Pascoe and co-workers
found that stride length decreased when wearing a
loaded backpack over 1 or 2 shoulders with reference
to unloaded walking [19]. What could explain the dis-
crepancy between our present finding and that of Cot-
talorda et al. and Pascoe et al.? Apart from the fact
that these two studies were among either children or
adolescents unlike our present study which is among
young adults, Cottalorda et al. did not use percentage
body weight for the amount of loading for the back-
pack. Likewise, the weight of the back pack used by
Pascoe and colleagues was much heavier (17.7% of
body weight) compared to the 15% of body weight
used in our study. Therefore varied loading and age dif-
ference may be responsible for the different findings.
Given the recommendation of 15% body weight load
as the upper boundary for safe load to be carried in
a back pack, we have utilized 15% body weight and
found that stride length and duration are not altered by
acute back pack loading with normal walking speed.
There was no significant difference found in veloc-
ity under three test conditions. This is contrast with
the findings of Connolly et al. who reported that veloc-
ity decreased when backpack was worn on 1 shoulder
and increased from baseline when the backpack was
worn on 2 shoulders [20]. They speculate that the ve-
locity was decreased during the 1 shoulder carriage be-
cause of the asymmetrical load causing the center of
gravity to shift laterally and to slow down the walk.
The report of Conolly and colleagues is interesting be-
 U.O. Abaraogu et al. / Effect of single and double backpack strap loading on gait and perceived exertion of young adults
cause with lesser time duration on self-selected walk-
ing wearing 15% of body weight, gait speed was de-
creased. Working independently, Chow and fellow re-
searchers as well as Kinoshita also reported that walk-
ing speed decreased with increasing loads even if the
backpack was worn over 2 shoulders [17,21]. How can
our contrasting results be explained? First, it will be
interesting to note that these reports of significant in-
fluence of load/strap type on gait were results of exper-
iment conducted among children and adolescents. The
question therefore is: does loading and strap patterns
have differential effect on gait parameter that is medi-
ated by age given that even lesser time exposure with
back pack loading had elicited decrease in gait speed?
Could it be that children and adolescents have not yet
mature their neural control of locomotion such that ex-
ternal load could easily alter the neural selection of
walking pattern/speed? It does suggest from our find-
ing that these influences are no longer as marked with
maturity into adult life. A prospective study is needed
to test this hypothesis.
In the present study, there was no significant dif-
ference in the step length and duration between the
three test conditions. This is in contrast with findings
of Kin et al. who in 2006 reported that when sub-
jects walked without a bag, step lengths were found
to be higher compared to walking with load [22]. Two
other researchers found that when subjects carried dif-
ferent loads and walked with self-selected speed, with
an increase of load the step length decreased while the
cadence increased with respect to an unloaded con-
dition [21,23]. Surprisingly, neither variation in step
length nor cadence was found in our current study. Cer-
tainly, this pose yet again a very important question re-
garding adaptation of the neurolocomotive system in
children and adolescents compared to adults. The ques-
tion therefore is: at what age does the human locomo-
tive apparatus adapts to backpack loading such that gait
parameters are maintained or at least with acute load
of back pack irrespective of preferred strap pattern?
Our findings showed a significant increase in per-
ceived exertion transcending from walking without
backpack to walking carrying single and double back-
pack irrespective of whether it was carried on 1 or 2
straps. This concord with previous finding by Goshin
and Rorke, and lends support to relationship between
perceived exertion and increase in the amount of
load [24]. Several other studies have assessed the cor-
relation of perceived exertion with increasing load with
report of positive correlation [25,26]. With respect to
carriage pattern and strap, Ikeda and colleagues [27]
113
found a significant decrease in perceived exertion when
carrying a two-strap golf bag versus the same bag with
one straps golf bag of 12.7 kg unlike our present study
that found no difference in perceived exertion between
1 and 2 strap walking. Could this be explained? It could
be argued that our subjects walked with no load ver-
sus 1 versus 2 straps on a self-selected normal walking
speed unlike the participants in Ikeda et al. that walked
at a preset treadmill speed of 3 miles/hour at 2 gradi-
ents. Their preset speed may be well out of many of the
participants’ self-selected speed hence the tendency of
fatigue from increase energy expenditure due to un-
comfortable walking speed in some participants. Also
walking duration in the study by Ikedia and colleagues
were longer compared to the duration of 6 minutes uti-
lized in our present study. Its therefore yet unknown if
there will be altered exertion if participants are exposed
to more than 6 minute of walking.
5. Conclusion
The study involved 25 young healthy individuals
who were engaged in a six minute walk under three
test conditions (unloaded, single strapped and double
strapped bag). Our result showed no significant differ-
ence in the gait parameters (stride length, stride time,
step length, step time, velocity cadence) under the
three test conditions. There was a significant increase
in perceived exertion as the individuals walked with
single strapped backpack compared with unloaded
condition, and also an increase in perceived exertion as
the individual walked with double strapped bag com-
pared with unloaded condition. However, there was no
significant difference in perceived exertion when the
individual walked with single strapped backpack com-
pared with double strapped backpack.
It could therefore be concluded that young adults
during normal speed walking, specifically for short dis-
tance and duration, do not alter their gait pattern when
carrying backpacks whether they carry it on 1 shoul-
der strap or on 2 shoulder straps so far they maintain
a self-selected normal speed walking. However, main-
taining these normal walking patterns may be at the
expense of increased somatic stress consequently in-
creasing perceived exertion. Importantly, the rate of the
perceived exertion due backpack loading is not depen-
dent on whether a backpack is carried on 1 strap or on
2 straps.
114 U.O. Abaraogu et al. / Effect of single and double backpack strap loading on gait and perceived exertion of young adults
6. Limitations
There are several limitations in our study. First, we
did not analyze the results based on which shoulder the
subjects wore the backpack on during the 1 shoulder
carriage. Subjects were given the option of carrying the
backpack on either shoulder, precluding an adequate
sample size to conduct an analysis of the effects on
gait by shoulder selected for the 1 strap carriage con-
dition. Secondly, only 15% body weight was used for
the present study making it impossible to generalize
the finding to other weight heavier or lighter than 15%
of body weight. Finally, we only explored 6 minute
walk test and only made participants to undergo nor-
mal speed walking. Therefore we are not able to say
what may happen to the gait parameters with longer
duration of walking or varied velotypes under the three
test conditions. Also we could not say if perceived ex-
ertion will differ between 1 strap and 2 strap condi-
tions at longer walking duration and self- selected fast
walking or self-selected slow walking. Therefore, fu-
ture studies should use varied loads under longer walk-
ing duration (12 minute walking), and should check if
there will be difference in gait and perceived exertion
when a backpack is carried with a strap on the dom-
inant shoulder or non-dominant shoulder. Such future
studies should also explore the picture when the other
walking speeds/velotypes (e.g. velot 4 or 5) aside nor-
mal walking speed is selected.
7. Clinical and research implication of this study
We found significant differences in the perceived
exertion during carriage of 15% body weight back
pack in six minute self-selected normal walking speed
which might suggest that the use of backpacks on 1
shoulder or 2 shoulders create problems with increase
fatigue. And contrary to widely held view, this in-
crease fatigue is not ameliorated by 2 straps carriage
of the backpack. Our study supports that physiother-
apist should not expect to see significant differences
in gait parameters when evaluating backpack use of
young adults without pathology during walks of short
durations with loads limited to 15% even when there
are reports of fatigue. Its our belief that studies concen-
trating on longer stride, dynamic balance mechanisms,
particularly assessing postural changes of the trunk and
lower extremities in frontal plane is needed to unlock
the mechanism of human gait adaptation to backpack
loading. This is because there seems a dearth of clini-
cal research to support the available guidelines on how
backpacks should be worn and the safe weight limits.
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