BackgroundGround reaction forces (GRFs) are important for understanding the biomechanics of human movement but the measurement of GRFs is generally limited to a laboratory environment. Wearable devices like accelerometers have been used to measure biomechanical variables outside the laboratory environment, but they cannot directly measure GRFs. Previous studies have used neural networks to predict the entire GRF waveform during the stance phase from wearable device data, but these networks require normalization of GRFs to the duration of a step or stance phase, resulting in a loss of the GRF waveformâs temporal component. Additionally, previous studies have predicted GRF waveforms during level-ground, but not uphill or downhill running. A method of predicting the normal (perpendicular to running surface) GRF waveform using wearable devices across a range of running speeds and slopes, while maintaining the GRF waveformâs temporal component, could allow researchers and clinicians to predict kinetic and kinematic variables outside the laboratory environment.PurposeWe sought to develop a recurrent neural network capable of predicting normal GRF waveforms across a range of running speeds and slopes using data from accelerometers located on the sacrum and shoe.Methods19 subjects completed 30-s running trials on a force-measuring treadmill at five slopes (0°, ±5°, ±10°) and three speeds (2.5, 3.33, and 4.17 m/s) per slope. One biaxial accelerometer was adhered to the sacrum and two uniaxial accelerometers were adhered to the right shoe during all trials. Accelerometers on the shoe were used to classify foot strike patterns as rearfoot, midfoot, or forefoot, and sacral acceleration data were divided into overlapping 12-ms windows, allowing the neural network to iteratively predict the experimentally-measured normal GRF waveform frame-by-frame. The mean, SD, and range of accelerometer data for each 12-ms window were included as neural network input features, along with the subjectâs body mass, height, running speed, slope, and percentage of a trialâs steps classified as a rearfoot, midfoot, or forefoot strike. We assessed the accuracy and generalizability of the neural network using leave-one-subject-out cross validation, which provided an ensemble of Root Mean Square Error (RMSE) and relative RMSE (rRMSE) values comparing the normal GRF waveform predicted by the neural network to the normal GRF waveform measured by the force-measuring treadmill. Additionally, we calculated the mean absolute percent error (MAPE) of step frequency, contact time, normal impulse, normal GRF active peak, and loading rate between the predicted and measured GRF waveforms.ResultsThe average ± SD RMSE was 0.16 ± 0.04 BW and rRMSE was 6.4 ± 1.5% for neural network predictions of each subjectâs normal GRF waveform compared to measured GRF waveforms across all conditions. RMSE values were lower during slow uphill running (2.5 m/s, +10°; 0.13 ± 0.07 BW) compared to fast downhill running (4.17 m/s, â10°; 0.20 ± 0.05 BW). The MAPE ± SD for step frequency was 0.1 ± 0.1%, contact time was 4.9 ± 4.0%, normal impulse was 6.4 ± 6.9%, normal GRF active peak was 8.5 ± 8.2%, and loading rate was 27.6 ± 36.1%.ConclusionsWe developed a recurrent neural network that uses accelerometer data to predict the continuous normal GRF waveform across a range of running speeds and slopes. The neural network does not require preliminary identification of the stance phase, maintains the temporal component of the GRF waveform, can be applied to up- and downhill running, and facilitates the prediction of kinetic and kinematic variables outside the laboratory environment. This represents a substantial step towards accurately quantifying and monitoring the external loads experienced by the body when running outdoors.