Lower body positive pressure (LBPP) treadmills, popularly known as anti-gravity treadmills are increasing in attractiveness, especially in sports and rehabilitation medicine. [1][2][3][4][5] A key purpose of exercising on LBPP treadmills is to be able to maintain or enhance aerobic exercise capacity while restricting the stress induced by ground reaction forces on the lower extremities, experienced when running on a regular treadmill or on the ground, under natural conditions. 6 In the past, before LBPP treadmills were available, such set-ups were created using harness systems that would be attached to the ceiling and provide upward force to mimic weightless running.7 The 'anti-gravity' effect afforded by the LBPP treadmills stems from the provision of body weight support (BWS) to the user. BWS is essentially an upward lifting force, allowing the user to train at a certain percentage of their body weight, and allowing aerobic exercise to occur at a reduced stress to the lower extremities. LBPP treadmills have the capability to decrease a user's body weight from 100% to 20% of original body weight, in 1% increments. By virtue of providing BWS, exercising on LBPP treadmills requires less effort, than under natural circumstances, resulting in lesser cardiovascular training stimulus. 8 Existing research has shown that exercising on a LBPP treadmill lowers metabolic expenditure, and increasing BWS further reduces oxygen consumption (VO2). However, the exact correlation between VO2, heart rate, and the BWS provided is not well established. Grabowski et al. showed the reduction in VO2 is not linearly proportional to the amount of BWS provided, which is particularly true for higher levels of weight support.6 They demonstrated that metabolic expenditure was reduced by 45% when providing 75% BWS, compared to walking without BWS. Subsequently, in a study of 12 healthy active adults, Hoffman et al. showed that though the relationship between heart rate and VO2 was linear, and not altered by three BWS levels (0%, 25% and 50%), the relationship between VO2 and BWS was not linear. 9 In another study, comprising male recreational runners, Vaughan et al. showed that a 20% reduction in body weight resulted in about 15% decrease in oxygen consumption and about 8% reduction in heart rate. 10 The nonlinear change in heart rate with varying degree of BWS and different treadmill speeds is presented in the Table 1. Based on these findings, the following formula was proposed by the author for predicting VO2 when running on a LBPP treadmill:where velocity is the running speed (kmÁhour), %BW is % body weight (or 100 -%BWS) and BM is body mass in kilogram.
10Studies have further demonstrated that though individuals are able to match their maximal oxygen consumption (VO2-max) while running on a LBPP treadmill, when compared to running on a non-BWS treadmill, they achieve this by running at a faster speed or for longer durations. This is required to compensate for the decreased metabolic expenditure associated with