Full Research

JSS COLLEGE OF PHYSIOTHERAPY
UG PROJECT
Assessment of heart rate variability and energy

expenditure index during ambulation on uneven
surfaces in healthy young adults aged 18-30 years
Mohammed Yaseen
Guide: Muhammed Rashid,
(PhD)
Date: 29-09-2023
Slide no: 01
Template provided by: “posters4research.com”
CONTENTS
Chapter I: Introduction
1.0 Background
1.1 Need of study
1.2 Hypotheses
1.3 Objective of the study
Chapter II: Literature Review

2.0 Introduction and areas of literature review
2.1 overview of section
2.2 keywords used
2.3 Individual sections
2.4 summery of individual sections
2.4.1 Section A: HRV, physiological effects and abstract of articles
2.4.2 Section B: EEI, potential application and abstract of articles
2.4.3 Section C: Challenges related to ambulation on uneven surfaces and abstract of articles
2.4.4 Section D: Characteristics of specific health adults and abstract of articles
2.4.5 Section E: Methods to evaluate EEI, HRV and respective validity and reliability
2.4.6 Section F: Methodological consideration
2.4.7 Section G: Overall summery of literature review
Date: 29-09-2023
Slide: 02
Chapter III: Methodology
3.0 Methodology
3.1 Study design
3.2 Study setting
3.3 Sampling strategy
3.4 Sample size
3.5 Participant characteristics
3.5.1 Inclusion criteria
3.5.2 Exclusion criteria
3.6 Procedure
3.7 Data analysis
3.8 Master data sheet
3.9 Outcome measure
Chapter IV: Results

4.1 Demographic data of participants
4.2 Comparison of HRV on different surfaces
4.3 Comparison of EEI on different surfaces
4.4 Comparison of HRV and EEI on different surfaces
Date: 29-09-2023
Slide: 03
References
Appendices
Date: 29-09-2023
Slide: 04
INTRODUCTION
1.0 BACKGROUND
The key components of the title are
Assessment of heart rate variability and energy expenditure index during ambulation on
uneven surfaces in healthy young adults aged 18-30 years
• Heart Rate Variability (HRV) refers to the variation in time intervals between consecutive
heartbeats. It is a measure of the beat-to-beat changes in heart rate, reflecting the dynamic
balance between the sympathetic and parasympathetic branches of the autonomic nervous
system.
Date: 29-09-2023
Slide: 05
• Energy Expenditure Index (EEI) , also known as, Physiologic Cost Index (PCI) is a
measurement to assess the energy expenditure or physiological effort required to perform a
specific task or activity. It is calculated using the formula that (heart rate during activity- heart
rate during rest) / walking speed.
(A. C. Pinheiro Volp; F. C. Esteves de Oliveira; R. Duarte Moreira Alves; E. A. Esteves; et al.
2011)
• Ambulation on uneven surface refers to walking on surfaces such as grass, road, sand and
pebbles.
• Healthy young adults refers to adults aged between 18-30 years without any known diseases .
Date: 29-09-2023
Slide: 06
1.1 NEED FOR THE STUDY
• In many low- and middle-income countries, individuals in rural regions heavily rely
on navigating uneven terrains composed of diverse textures, such as loose-packed
surfaces comprising sand and pebble.
• Hence, Navigation on uneven terrain is essential for rural residents of regions in

much of the developing world even for basic activities of daily living.
• While existing literature has investigated kinematic and kinetic variables of gait and
sway parameters during ambulation on uneven terrains, the impact on EEG and HRV
remains largely unexplored.
(Rashid et, al. 2020, Rashid et, al. 2022)
Date: 29-09-2023
Slide: 07
• The international classification of functioning, disability, and health listed 'walking
on different surfaces' in the brief coreset for stroke. Hence, walking on various
platform has to be promoted by health care workers.
• The excessive energy demands required for ambulation on uneven surfaces can serve
as a limiting factor, hindering individuals from engaging in such activities.
Consequently, these circumstances may lead to enforced confinement within their
homes, that can potentially decrease their overall quality of life (QOL).
• Understanding the physiological responses, specifically changes in EEG and HRV,

during ambulation on uneven surfaces is crucial for optimizing interventions and
designing appropriate rehabilitation strategies.
• This pilot study seeks to explore the changes in EEG and HRV patterns observed
during ambulation on various uneven surfaces, including road, grass, sand, and
pebble. The study will focus on a cohort of healthy young adults between the ages of
18 and 30 years.
Date: 29-09-2023
Slide: 08
1.2 HYPOTHESES
Null hypotheses
• There is no difference in HRV and EEI during uneven surface ambulation on different
platforms
Alternative hypotheses
• There is difference in HRV and EEI during uneven surface ambulation on different platforms
Date: 29-09-2023
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1.3 OBJECTIVES
1.2 OBJECTIVE
• To assess the alterations in HRV during ambulation on uneven surfaces in healthy young adults
aged 18-30 years using polar heart rate monitor.
• To assess the alterations in EEI during ambulation on uneven surfaces in healthy young adults
aged 18-30 years using polar heart rate monitor.
Date: 29-09-2023
Slide: 10
2.0 REVIEW OF LITERATURE
The literature search was conducted using the electronic data base via google scholar and
PubMed. The articles were searched with relevant keywords under relevant sections.
Search strategy
Databases used: Google Scholar, PubMed
Search limits/ filters applied: English
Number of total articles used cited in the review of literature: 44
Date: 29-09-2023
Slide: 11
2.2 Keywords used for each section
Keywords used Number of articles cited in

the review of literature
Section 1 (Heart rate variability OR HRV) 8

AND (definition)
Section 2 (EEI OR Energy expenditure 7

index) AND (definition)
Section 3 (Ambulation OR Locomotion OR 12

gait) AND (uneven surface)
Section 4 (HRV OR EEI) AND (young 03

adults)
(evaluation methods) AND (EEI
Section 5 OR HRV) AND (validity) AND 10
(reliability)
(Sample size OR data analysis)

Section 6 AND (Survey) 04
Date: 29-09-2023
Slide: 12
2.3 Individual sections
•2.1 Heart Rate Variability (HRV)
•2.1.1 Definition and concept of HRV

•2.1.2 Physiological basis of HRV and its interpretation in relation to cardiovascular health and fitness
•2.1.3 Summary of previous studies that have investigated HRV during ambulation or exercise
•2.1.4: section summary
•2.2 Energy Expenditure Index (EEI):
•2.2.1 Definition and concept of EEI

•2.2.2 Methods used to calculate EEI and its potential applications
•2.2.3 Summary of relevant studies that have explored EEI during various types of ambulation or exercise
•2.2.4: section summary
Date: 29-09-2023
Slide: 13
Individual section contd…
•2.3 Ambulation on Uneven Surfaces (section 3)
•2.3.1 Challenges and demands associated with ambulation on uneven surfaces

•2.3.2 Biomechanical considerations and adaptations required during walking or running on uneven terrain
•2.3.3 Summary of existing literature that has examined the effects of uneven surfaces on HRV and EEI
•2.3.4: Section summary
•2.4 HRV and EEI in Healthy Young Adults: (section 4)
•2.4.1 Characteristics and considerations specific to healthy young adults aged 18-30 years.
•2.4.2 Summary of previous research on HRV and EEI during locomotion
•2.4.3 Section summary (200 words)
Date: 29-09-2023
Slide: 14
Individual section contd…
•2.5 Methods to evaluate EEI and HRV
•2.5.1: Methods to evaluate EEI

•2.5.1.1: Validity and reliability of these methods
•2.5.2: Methods to evaluate HRV
•2.5.2.1: Validity and reliability of these methods
•2.6 Methodological considerations
•2.6.1 Sample size calculation for observational studies

•2.6.2 Data analysis
•2.6.3 Section summary
•2.7 Overall summary
Date: 29-09-2023
Slide: 15
2.4.1 Section A summary
Heart rate variability (HRV) is the variation in time intervals between consecutive
heartbeats, reflecting the autonomic nervous system's sympathetic and parasympathetic
components.
(Yamamoto SS et al., 2010)
It is used to predict post-myocardial infarction prognosis and risk of sudden cardiac
death. HRV is influenced by cardiac problems, such as conduction issues and atrial
fibrillation, and is influenced by the complex interaction between physiological systems
and cerebral regulatory mechanisms.
(Taylor JA et at., 2016) and (Johnston BW et al., 2020)
Date: 29-09-2023
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The sympathetic nervous system (SNS) controls the body's fight-or-flight response,
causing faster electrical impulses and shorter heartbeat periods. The parasympathetic
nervous system promotes relaxation and healing, slowing electrical impulses and
increasing HRV as heartbeat intervals become longer.
(Thayer JF et al., 2010)
Monitoring HRV helps evaluate training adaptations and fitness levels. Studies show that
higher walking speeds and intense treadmill jogging reduce sympathetic dominance.
Recent evidence suggests that HRV indices with time windows as short as 10-30 seconds
are as reliable as short-term indices.
(Schroeder EB et al., 2004)
Date: 29-09-2023
Slide: 17
2.4.2 Section B summary
Energy Expenditure Index (EEI) is a measurement that evaluates the energy expenditure
or physiological effort required for a specific task or activity. It is calculated using the
formula (heart rate during activity- heart rate during rest) / walking speed.
(EA Esteves et al., 2011)
EE consists of three main components: basal metabolic rate, thermic effect of food or
diet-induced thermogenesis, and physical activity EE. Factors like age, body
composition, thyroid hormones, catecholamines, ambient temperature, disease states, and
drugs/treatments influence EE.
(Chen KY et al., 2013) and (EA et al., 2011)
Date: 29-09-2023
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Direct calorimetry provides insights into a person's metabolic response to exercise by
monitoring energy expenditure. It helps improve exercise performance by focusing on
specific energy systems.
(Leonard WR et al., 2012)
Indirect calorimetry quantifies human energy expenditure (EE) in research and clinical
settings, using resting metabolic rate (RMR) as a baseline and estimating metabolic
equivalents (METs) for exercise intensity. Indirect calorimetry measures oxygen and
carbon dioxide production, providing real-time data for assessing and modifying workout
intensity. EEI can be calculated using heart rate and walking speed, as walking speed has
a linear relationship with energy expenditure.
(P. Hills et al., 2018)
Date: 29-09-2023
Slide: 19
2.4.3 Section C summary
In low and middle-income countries, uneven surfaces require improved proprioception

and balance to maintain stability and avoid falls. Eccentric muscular contractions are
essential for regulating movement on uneven surfaces, but they can lead to muscle fatigue
and energy consumption.
(Kristine McLaughlin et al., 2015)
Healthy adults walk on uneven terrain, resulting in increased step length, width, and time.
Proper timing of lower extremity events throughout the gait cycle reduces energy demand
and increases joint effort to compensate.
(Voloshina AS et al., 2013)
Date: 29-09-2023
Slide: 20
•Energy consumption increases in locomotion on complex surfaces like grass, sand, and
snow, as well as on uneven terrain.
•Co-activation of muscles contributes to greater energy consumption. On difficult terrain,

knee and hip mechanical work increase, while total gait kinematics remains constant.
•(Davies SHE et al., 2006) and (Wade C et al., 2010)
•Studies have shown that changes in kinematic chains directly impact nearby joints, with
distal joints changing first. This study aims to determine the normative values of energy
consumption and heart rate variability by normal healthy persons on uneven surfaces,
focusing on the effect of heart rate interval and heart beat at working and at rest.
•(Daniel P et al., 2018)
Date: 29-09-2023
Slide: 21
2.4.4 Section D summary
The study done by Wier Jbdeb in 2017, aims to determine the normative values of HRV
and EEI in typical individuals. Indirect calorimetry offers more precise energy
requirements in patients with altered metabolic states, body sizes, and age extremes.
Regular physical exercise and fitness are linked to higher HRV in young people.
Psychological stress, anxiety, and depression can impact HRV, while smoking, alcohol
intake, and poor sleep quality can decrease HRV in young adults. Healthy lifestyle
behaviours, such as sleep, a balanced diet, and stress management, can also impact HRV.
HRV may be used as a potential marker for early diagnosis of health issues.
(Chan L-N et al., 2020) and (Weir Jbdeb et al., 2017)
Date: 29-09-2023
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It excludes individuals with cardiovascular, neurological, musculoskeletal, balance,
coordination, or medication-related issues. The research also excludes individuals with
sensory-perceptual problems or other pathologies that may impair safety.
(Chan L-N et al., 2020)
Date: 29-09-2023
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2.4.5 Section E summary
HRV analysis involves using ECG to measure autonomic nerve activity, ECG is
considered the gold standard for HRV measurement, with high validity and reliability.
(Cooper JA et al., 2009)
But wearable devices like polar heart rate monitors make it more convenient. Common
methods include time domain method, frequency domain method, and Fourier transform
or autoregressive modelling. Time domain methods calculate heart rate mean, difference
in day and night, respiration, and drug impact. Frequency domain methods provide
information about heart autonomic control.
(Orini M et al., 2010) and (Reena Tiwari et al., 2010)
Polar heart rate monitor is the next most acceptable device after ECG, it has nearly 100%
accuracy and very high validity and reliability.
(Ann ester et al., 2013)
Date: 29-09-2023
Slide: 24
Research gap
• The international classification of functioning, disability, and health listed 'walking

on different surfaces' in the brief coreset for stroke. Hence, walking on various
platform has to be promoted by health care workers.
• The excessive energy demands required for ambulation on uneven surfaces can
serve as a limiting factor, hindering individuals from engaging in such activities.
Consequently, these circumstances may lead to enforced confinement within their
homes, that can potentially decrease their overall quality of life (QOL).
Date: 29-09-2023
Slide: 25
• Understanding the physiological responses, specifically changes in EEG and HRV,
during ambulation on uneven surfaces is crucial for optimizing interventions and
designing appropriate rehabilitation strategies.
• While existing literature has investigated kinematic and kinetic variables of gait and
sway parameters during ambulation on uneven terrains, the impact on EEG and
HRV remains largely unexplored.
• This pilot study seeks to explore the changes in EEG and HRV patterns observed
during ambulation on various uneven surfaces, including road, grass, sand, and
pebble. The study will focus on a cohort of healthy young adults between the ages
of 18 and 30 years.
Date: 29-09-2023
Slide: 26
Justification for the methodology , sample size and equipment
•EEI
–validity- ICC: 0.824, CI 95% (0.703-0.896)
•HRV
–validity- the ICC ranged from 0.65 to 0.89, and the CV ranged from 0.9 to 19.8.
Date: 29-09-2023
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Chapter III: Methodology
6.1 Study design: Observational cross-sectional study

6.2 Study setting: JSS College of Physiotherapy
6.3 Sampling strategy: Convenience sampling
6.4 Sample size: 31
Date: 29-09-2023
Slide: 28
Date: 29-09-2023
Slide: 29
•The sample size for this study was calculated using GPower software version 3.1.9.4.
The statistical test chosen was an ANOVA repeated measures within-group design,
belonging to the F-test family. The effect size was estimated at 0.25, indicating the
magnitude of the expected differences between the measurements. The alpha error level
was set at 0.05, representing the acceptable probability of making a Type I error. The
desired power of the study was set at 0.95, indicating the probability of correctly
detecting significant effects if they exist. The study included five measurements
corresponding to different surfaces, namely sand, level, pebble, road, and grass. There
was only one group under investigation.
•The output from the GPower software indicated a total sample size of 31 participants.
Date: 29-09-2023
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3.5 Participant characteristics
Participants:
•The study will recruit a sample of healthy young adults aged between 18 and 30 years.
Participants will be selected based on the following inclusion and exclusion criteria:
Inclusion Criteria:
•Age between 18 and 30 years.
•Generally healthy without any known cardiovascular, neurological, or musculoskeletal disorders.
•Regular physical activity participation.
Exclusion Criteria:
Any cardiovascular, neurological, or musculoskeletal disorders.
•Use of medications or substances that may affect heart rate variability.
•Pregnant or planning to become pregnant during the study period.
Date: 29-09-2023
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3.6 Procedure
Preparation of the participant
•The height and weight of the participants were recorded. Participants were provided with
instructions to refrain from participating in any form of physical activity or consuming
any food for a duration of two hours preceding the assessment of their resting energy
expenditure. Additionally, participants were strictly prohibited from consuming alcohol
or caffeine for a duration of 2 hours prior to each test. The baseline measurements for
resting heart rate and energy expenditure were obtained before the initiation of
ambulation and served as the reference point for all subsequent calculations. The Polar
H10 heart rate sensor was fastened to the chest of the participants as per the user manual
provided by the Polar, and they were allowed to sit for five minutes.
Date: 29-09-2023
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Procedure contd…
Estimating the resting state heart rate

The resting state energy expenditure index was assessed for a duration of 3 minutes while
the participant was seated on a chair with a backrest. The procedure was repeated three
times and the average of these three measurements was considered as the resting state
heart rate.
Procedure
•Subsequently, the participants were instructed to engage in a 5-minute walk at a self-
selected comfortable pace on a randomly selected surface (using lottery) in a figure of
oval walkway to avoid sudden deceleration during ambulation. The energy expenditure
index on the surface was then computed. Assuming that the subjects had reached a
physiological steady state within the first 3 minutes, the data collected for the final 2
minutes of ambulation were utilized for the analysis of HRV and the calculation of the
EEI.
Date: 29-09-2023
Slide: 33
Procedure contd…
•After completing the walking trials on a level surface, participants were given a rest
period until their heart rate returned to the resting state (HR). Subsequently, one of the
remaining four walking surfaces (pebbled, sandy, road, or grass) was randomly selected
using a lottery method. This procedure was repeated, until the participant had completed
walking on all the designated platforms. The EEI values were then promptly recorded
immediately after the completion of ambulation on each surfaces. The entire testing
procedure was completed on the same day to avoid external factors that can influence
the heart rate variables. Participants were allowed to use their regular footwear.
Date: 29-09-2023
Slide: 34
Procedure contd…
Estimation of EEI
•The estimation of Energy Expenditure Index (EEI) was performed utilizing the formula
developed by Rose et al. EEI was calculated by dividing the difference between the
walking heart rate (HR) and resting heart rate (HR) by the walking speed, expressed as
beats per minute per meters per minute (beats/min/m).
•EEI = (walking HR - resting HR) / walking speed
Date: 29-09-2023
Slide: 35
3.7 Data analysis
•Descriptive statistics were calculated to summarize the demographic characteristics of

the participants, including their height and weight measurements. The normality of the
data was assessed using the Shapiro-Wilk test, which indicated that the data were
normally distributed. To compare the EEI and HRV of healthy adults during ambulation
on different platforms (level surface, road, grass, pebbles, and sand), a one-way analysis
of variance (ANOVA) was conducted. The significance level was set at α = 0.05. Post
hoc analysis using the Bonferroni correction was performed to identify specific group
differences
Date: 29-09-2023
Slide: 36
3.8 Master data sheet
Date: 29-09-2023
Slide: 37
3.9 Outcome measure
In my situation, I chose to measure HRV using a polar heart rate monitor and EEI by
polar heart rate monitor and indirect calorimetry respectively, since the polar heart rate
monitor has proven a high degree of reliability, and the reason for using indirect
calorimetry is that it is convenient, feasible, and user-friendly .
Date: 29-09-2023
Slide: 38
Chapter IV: Results
Demographic data of participants
HEIGHT WEIGHT BASELINE

AGE GENDER BMI
(cms) (kgs) HR
Male = 01
21.2 ±1.38 162.94±9.05 57.65±10.72 21.64±3.05 77.05±8.04
Female =02
Date: 29-09-2023
Slide: 39
HRV
•This F-statistic does not exceed the critical value, suggesting that there is no statistically significant
difference between the groups concerning Heart Rate Variability.
•Additionally, the associated p-value of 0.585 further supports this interpretation, as it is greater than the
conventional significance level of 0.05. Thus, we conclude that there is no statistically significant difference
in Heart Rate Variability between the groups.
•This implies that there are no statistically significant differences in HRV between any of the groups (e.g.,
Level surface, Sand, Pebbles, Road, and Grass).
Groups n Mean Standard F-statistics P-value
deviation
Normal 35 34.34285 9.722450
Sand 35 32.25714 10.42153
Pebbles 35 32.94285 9.955615 0.711 0.585

Asphalt 35 35.91428 9.347448
Grass 35 33.6 9.882247

Date: 29-09-2023
Slide: 40
EEI
•The F-statistic is computed as 1.419, which is higher than the critical value.
•However, the associated p-value of 0.230 is greater than 0.05, indicating that the difference in
EEI between the groups is not statistically significant.
•For EEI, the comparisons also reveal p-values greater than 0.05, indicating that there are no
statistically significant differences in EEI between any of the groups (e.g., Level surface, Sand,
Pebbles, Road, and Grass).
Groups n Mean Standard F-statistics P-value

deviation
Normal 35 0.459903 0.183998

Sand 35 0.491624 0.157373
Pebbles 35 0.538243 0.161905 1.419 0.230
Asphalt 35 0.455709 0.151664
Grass 35 0.493204 0.166448
Date: 29-09-2023
Slide: 41
Reference
1. The benefits of walking on uneven ground [Internet]. Charlottewattshealth.com. [cited 2023 May 16]. Available
from: https://www.charlottewattshealth.com/blog/the-benefits-of-walking-on-uneven-ground
2. Voloshina AS, Kuo AD, Daley MA, Ferris DP. Biomechanics and energetics of walking on uneven terrain. J
Exp Biol [Internet]. 2013; Available from: http://dx.doi.org/10.1242/jeb.081711
3. Thayer JF, Yamamoto SS, Brosschot JF. The relationship of autonomic imbalance, heart rate variability and
cardiovascular disease risk factors. Int J Cardiol [Internet]. 2010; 141(2):122–31. Available from:
http://dx.doi.org/10.1016/j.ijcard.2009.09.543
4. Heart rate variability: standards of measurement, physiological interpretation and clinical use. Task Force of
the European Society of Cardiology and the North American Society of Pacing and Electrophysiology.
Circulation. 1996;93(5):1043–65.
5. Volp P, De Oliveira E, Moreira Alves D, Esteves R, Bressan EA. Energy expenditure: components and
evaluation methods. Nutr Hosp [Internet]. 2011; 26(3):430–40. Available from:
http://dx.doi.org/10.1590/S0212-16112011000300002
6. Wiart L, Darrah J. Test–retest reliability of the energy expenditure index in adolescents with cerebral palsy.
Dev Med Child Neurol [Internet]. 1999; 41(10):716–8. Available from:
http://dx.doi.org/10.1017/s0012162299001450
7. Rashid M, Mathew J. Kavitha Raja - Alteration in ankle kinematics during uneven surface ambulation in stroke
survivors: An exploratory observational study. 2023.
8. Heart rate variability: how it might indicate well-being. December. 2021; 1.
9. Pham T, Lau ZJ, Chen SHA, Makowski D. Heart rate variability in psychology: A review of HRV indices and an
analysis tutorial. Sensors (Basel) [Internet]. 2021; 21(12):3998. Available from:
http://dx.doi.org/10.3390/s21123998
10. Stephenson MD, Thompson AG, Merrigan JJ, Stone JD, Hagen JA. Applying heart rate variability to monitor
health and performance in tactical personnel: A narrative review. Int J Environ Res Public Health [Internet].
2021;18(15):8143. Available from: http://dx.doi.org/10.3390/ijerph18158143 Template provided by: “posters4research.com”
11. Decreased Postural Sway in Women Who Are Visually Impaired: Is it a Learned Protective Mechanism? Muhammed
Rashid, Sherin Siby, Sandeep Padantaya Harish , Anoop Joy , Arun Gopi , Jerin Mathew , and Kavitha Raja.
12. Sekiguchi Y, Honda K, Izumi S-I. Effect of walking adaptability on an uneven surface by a stepping pattern on walking
activity after stroke. Front Hum Neurosci [Internet]. 2021; 15:762223. Available from:
http://dx.doi.org/10.3389/fnhum.2021.762223
13. Energy expenditure: components and evaluation methods A C Pinheiro Volp 1, F C Esteves de Oliveira, R Duarte
Moreira Alves, E A Esteves, J Bressan
14. Alteration in ankle kinematics during uneven surface ambulation in stroke survivors: An exploratory observational study
Muhammed Rashid, Jerin Mathew, Kavitha Raja
15. Energy efficiency of ambulatione A comparison of various orthopaedic possibilities Jerin Mathew a, Kavitha Raja b, Febin
PBaby c, Basima Barikkal
An Overview of Heart Rate variability Metrics and Norms Fred Shaffer and. J P Ginsberg Center for Applied
16.
Psychophysiology.
Gevirtz RN, Lehrer PM, Schwartz MS. Biofeedback: A Practitioner’s Guide. Schwartz MS, Andrasik F, editors. New York:
17.
The Guilford Press; 2016.
Johnston BW, Barrett-Jolley R, Krige A, Welters ID. Heart rate variability: Measurement and emerging use in critical care
18. medicine. J Intensive Care Soc [Internet]. 2020;21(2):148–57. Available from:
http://dx.doi.org/10.1177/1751143719853744
Catai AM, Pastre CM, Godoy MF de, Silva E da, Takahashi AC de M, Vanderlei LCM. Heart rate variability: are you using
19. it properly? Standardisation checklist of procedures. Braz J Phys Ther [Internet]. 2020;24(2):91–102. Available from:
http://dx.doi.org/10.1016/j.bjpt.2019.02.006
Schroeder EB, Whitsel EA, Evans GW, Prineas RJ, Chambless LE, Heiss G. Repeatability of heart rate variability
20. measures. J Electrocardiol [Internet]. 2004;37(3):163–72. Available from: Template provided by: “posters4research.com”
Thayer JF, Yamamoto SS, Brosschot JF. The relationship of autonomic imbalance, heart rate variability and
21. cardiovascular disease risk factors. Int J Cardiol [Internet]. 2010;141(2):122–31. Available from:
http://dx.doi.org/10.1016/j.ijcard.2009.09.543
Draghici AE, Taylor JA. The physiological basis and measurement of heart rate variability in humans. J Physiol
22.
Anthropol [Internet]. 2016;35(1):22. Available from: http://dx.doi.org/10.1186/s40101-016-0113-7
Pinheiro Volp AC, Esteves de Oliveira FC, Duarte Moreira Alves R, Esteves EA, Bressan J. Energy expenditure:
23. components and evaluation methods. Nutr Hosp [Internet]. 2011;26(3):430–40. Available from:
http://dx.doi.org/10.1590/S0212-16112011000300002
Psota T, Chen KY. Measuring energy expenditure in clinical populations: rewards and challenges. Eur J Clin Nutr
24.
[Internet]. 2013;67(5):436–42. Available from: http://dx.doi.org/10.1038/ejcn.2013.38
Energy Expenditure During Ambulation with Ortho Crutches and Axillary Crutches Get access Arrow Catherine A
25.
Hinton. Karen E Cullen Physical Therapy. 1982;62(6):813–9.
Energy efficiency of ambulation A comparison of various orthopaedic possibilities Jerin Mathew, Kavitha Raja.
26.
Febin P. Baby, Basima Barikkal;
Brychta R, Wohlers E, Moon J, Chen K. Energy expenditure: measurement of human metabolism. IEEE Eng
27.
Med Biol Mag [Internet]. 2010;29(1):42–7. Available from: http://dx.doi.org/10.1109/MEMB.2009.935463
Leonard WR. Laboratory and field methods for measuring human energy expenditure. Am J Hum Biol [Internet].
28.
2012;24(3):372–84. Available from: http://dx.doi.org/10.1002/ajhb.22260
Assessment of physical activity and energy expenditure: an overview of objective measures Andrew P. Hills 1,2*,
29.
Najat Mokhtar 3 and Nuala M. Byrne4 1 Centre for Nutrition and Exercise.
Standing balance on unsteady surfaces in children on the autism spectrum: The effects of IQ Author links.
30.
Douglas C. Dean III c, Kristine McLaughlin; Template provided by: “posters4research.com”
Comparison of sway meter and Kinovea software as a tool of measurement for the sway parameters during quiet
31.
standing: An observational study Muhammed Rashid a,* , Sherin Siby b. Jerin Mathew c.
Validity and reliability of the Kinovea program in obtaining angles and distances using coordinates in 4
32. perspectives Albert Puig-Diví,Carles Escalona-Marfil. In: Josep Maria Padullés-Riu. Albert Busquets,Xavier
Padullés-Chando,Daniel Marcos-Ruiz;
Walking on uneven terrain in healthy adults and the implications for people after stroke Kelly A Hawkins, DPT1.
33.
David J Clark, ScD2,3, Chitralakshmi K Balasubramanian, PT, PhD4, and Emily J Fox, DPT, PhD;
Adaptations of walking pattern on a compliant surface to regulate dynamic stability Michael J MacLellan 1, Aftab
34.
E Patla. Aftab E Patla Aftab E Patla.
Kuo AD, Donelan JM, Ruina A. Energetic consequences of walking like an inverted pendulum: stepto-step
35.
transitions. Exerc Sport Sci Rev. 2005;33(2).
Voloshina AS, Kuo AD, Daley MA, Ferris DP. Biomechanics and energetics of walking on uneven terrain. J Exp
36.
Biol [Internet]. 2013;216(Pt 21):3963–70. Available from: http://dx.doi.org/10.1242/jeb.081711
Davies SEH, Mackinnon SN. The energetics of walking on sand and grass at various speeds. Ergonomics
37.
[Internet]. 2006;49(7):651–60. Available from: http://dx.doi.org/10.1080/00140130600558023
Pinnington HC, Dawson B. The energy cost of running on grass compared to soft dry beach sand. J Sci Med
38.
Sport [Internet]. 2001;4(4):416–30. Available from: http://dx.doi.org/10.1016/s1440-2440(01)80051-7
Wade C, Redfern MS, Andres RO, Breloff SP. Joint kinetics and muscle activity while walking on ballast. Hum
39.
Factors [Internet]. 2010;52(5):560–73. Available from: http://dx.doi.org/10.1177/0018720810381996
40. Arthur D. Direction-dependent control of balance during walking and standing Shawn M O’Connor 1. Template provided by: “posters4research.com”
SUBJECT INFORMATION SHEET
Title: Assessment of heart rate variability and energy expenditure index during ambulation on
uneven surfaces in healthy young adults aged 18-30 years
Principal investigator: Mr Mohammed Yaseen, BPT, JSS College of physiotherapy Mysuru

Co-Investigator: Muhammed Rashid, PhD, JSS College of Physiotherapy Mysuru.
Site: ....................................................................................................................................
Principal investigator Co-Investigator Institution
Mr Mohammed Yaseen, Mr Muhammed Rashid, PhD JSS College of Physiotherapy

+919742549465 +919048368029 jsscpt@jssonline.org
0821-2548234
Date: 29-09-2023
Slide: 46
•Purpose of research: I have been informed that this study is intended to see the heart
rate variability and energy expenditure index during ambulation on uneven surfaces in
healthy young adults aged 18-30 years
•Procedure: I understand that I will be asked to walk on uneven 5 different uneven

surfaces. I understand that I should expose my body parts, and colour markers will be
fixed on my body for visibility if necessary and the complete the procedure or a part of it
will be recorded during the event. I have the rights to stop the procedure when I wish
because of feeling of fatigue or any other discomfort. None of this procedure requires me
to be hospitalized.
Date: 29-09-2023
Slide: 47
•Duration: 3 months
•Risks and discomfort: I have been informed that there exists the possibility of certain
changes occurring during the event. These include difficulty in continuing the walking,
loss of balance and other discomforts. Every effort will be made to minimize these risks
by evaluation of preliminary information relating to your health and fitness and by
careful observations during the procedure.
•Benefits: I understand that the results of the study will help the investigator to find
the............................................................... This will help in formulating……………….
•Payment for participation: I understand that I may not be paid for participation
.
Date: 29-09-2023
Slide: 48
•Confidentiality: The captured videos will be used only for the purpose of study and will
not be transferred or given by hand to any other person or institution or social medias
without your written consent. However, the information may be used for statistical
analysis, publication or for teaching purposes with your right to privacy retained
•Request for more information: I understand that I may at any time request more
information about the study. I will be informed about any significant new information
that may affect me or influence my further participation in the study.
•Withdrawal from the study: I understand that I may at any time withdraw from the
study and my participation is completely voluntary.
Date: 29-09-2023
Slide: 49
•Injury statement: I understand that in the unlikely event of injury to me resulting
directly from my participation in this study, appropriate treatment would be available to
me, but no further compensation would be provided by the investigators or Institution. I
am aware that by agreeing to participate in this study, I am not waiving any of my legal
rights.
•Investigator’s statement: I have explained to the subject, purpose of the research, the
procedures required and the possible risks and benefits to the best of my ability in
participant comfortable language.
Date: 29-09-2023
Slide: 50
INFORMED CONSENT FORM
Project title: Assessment of heart rate variability and energy expenditure index during ambulation
on uneven surfaces in healthy young adults aged 18-30 years
Name and age of the participant:
I have read the subject information sheet and its contents were explained. I had the opportunity to
ask questions and received satisfactory answers.
I understand that my participation in the study is voluntary and that I have the right to withdraw at
any time without giving any reason, without my medical care or legal rights being affected.
I agree to take part in the above study. I confirm that I have received a copy of the subject
information sheet along with this signed and dated informed consent form.
Signature & name of the participant Date
Signature & the name of the witness Date

Date: 29-09-2023
Slide: 51
THANK YOU

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JSS COLLEGE OF PHYSIOTHERAPY

Assessment of heart rate variability and energy

Chapter II: Literature Review

Chapter IV: Results

The key components of the title are

• Hence, Navigation on uneven terrain is essential for rural residents of regions in

• Understanding the physiological responses, specifically changes in EEG and HRV,

Keywords used Number of articles cited in

Section 1 (Heart rate variability OR HRV) 8

Section 2 (EEI OR Energy expenditure 7

Section 3 (Ambulation OR Locomotion OR 12

Section 4 (HRV OR EEI) AND (young 03

(Sample size OR data analysis)

•2.1 Heart Rate Variability (HRV)

•2.1.1 Definition and concept of HRV

•2.2 Energy Expenditure Index (EEI):

•2.2.1 Definition and concept of EEI

•2.3 Ambulation on Uneven Surfaces (section 3)

•2.3.1 Challenges and demands associated with ambulation on uneven surfaces

•2.4 HRV and EEI in Healthy Young Adults: (section 4)

•2.5 Methods to evaluate EEI and HRV

•2.5.1: Methods to evaluate EEI

•2.6 Methodological considerations

•2.6.1 Sample size calculation for observational studies

•2.7 Overall summary

In low and middle-income countries, uneven surfaces require improved proprioception

•Co-activation of muscles contributes to greater energy consumption. On difficult terrain,

• The international classification of functioning, disability, and health listed 'walking

6.1 Study design: Observational cross-sectional study

Preparation of the participant

Estimating the resting state heart rate

•EEI = (walking HR - resting HR) / walking speed

•Descriptive statistics were calculated to summarize the demographic characteristics of

Demographic data of participants

HEIGHT WEIGHT BASELINE

Normal 35 34.34285 9.722450

Sand 35 32.25714 10.42153

Pebbles 35 32.94285 9.955615 0.711 0.585

Grass 35 33.6 9.882247

Groups n Mean Standard F-statistics P-value

Normal 35 0.459903 0.183998

Principal investigator: Mr Mohammed Yaseen, BPT, JSS College of physiotherapy Mysuru

Principal investigator Co-Investigator Institution

Mr Mohammed Yaseen, Mr Muhammed Rashid, PhD JSS College of Physiotherapy

•Procedure: I understand that I will be asked to walk on uneven 5 different uneven

Name and age of the participant:

Signature & name of the participant Date

Signature & the name of the witness Date

Template provided by: “posters4research.com”

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