Large scale kinematic studies add to justification for clinical trial of FRED, determine familiarisation time and provide recommendation on settings for exercise

Two large scale data collection periods run over two years in the summers of 2014 and 2015 recruited 308 total participants for kinematic studies of FRED, with almost half being clinically interesting having low back pain.  Participants were recruited by collecting data at the Newcastle Life Science Centre which you can read more about in our other article Mission X - Train like an astronaut.  These two data collections fed into four studies which aimed to achieve the following:

  1. Determine the influence of FRED exercise on lumbopelvic kinematics in people with and without low back pain.
  2. Investigate the effect of FRED-generated visual feedback on control of the exercise movements.
  3. Observe the effect of time, during FRED exercise, on lumbopelvic kinematics and movement control to establish the time first time device users require to familiarise to the exercise.
  4. Establish the effect of using the FRED handles during exercise on lumbopelvic kinematics

For those not already familiar with the FRED project, it is one the main projects within the Aerospace Medicine and Rehabilitation Lab.  Deep spinal muscles, Lumbar Multifidus and Transversus Abdomininus are often atrophied and dysfunctional in those with low back pain.  The FRED has shown the ability to recruit these muscles automatically, which is often a challenge in current rehabilitation methods.  As the Lumbar Multifidus also controls lumbar lordosis it was expected that exercise on the FRED would also promote lordosis if Lumbar Multifidus was active.  This was assessed in the first study, while the remaining three established evidence on which to base decisions regarding device settings that should be used during exercise.

The findings of the first study were published in the Musculoskeletal Science and Practice journal in January 2017.  It was found that the FRED promotes increased lumbar extension and anterior pelvic tilt compared to over ground walking.  Attaining a lordosis throughout the lumbar spine below thoracolumbar junction is a goal of current low back pain motor control interventions and is linked to key muscle activity.  Therefore this provided additional justification that the FRED should be trialled in those with low back pain as it appears it will be beneficial and might overcome current challenges in training people to activate key muscles and achieve lordosis.   These effects in the lumbopelvic region were seen in both those with and without low back pain, suggesting FRED will still have these effects in a clinical population.

The key findings of the remaining studies formed a part of Andrew Winnard's PhD thesis and some are under review for publication.  There was variation away from the target exercise frequency when visual feedback was not provided.  The target frequency is one expected to create the key muscle activity and is the speed at which such acitivy has been recorded in previous work.  Therefore it was recommended device users should use visual feedback.  It was found that it took 170 seconds for all users with and without back pain to familiarise to the exercise, providing a recommended minimum familiarisation period for future trials and clinical use of the device.  When the handles were used, effects considered beneficial were lost, such as the increased lumbar spine extension.  Therefore it was recommended that the handles are not used by FRED users once it is safe for them to let go.

These studies helped lead to the FRED low back pain intervention study which you can read about here: FRED low back pain intervention study