The effect of external lateral stabilization on energy cost of walking - A systematic review and meta-analysis

Previous studies have estimated the energy cost required for the control of medio-lateral stability in human walking by means of external lateral stabilization. Results were inconsistent, possibly due to differences in task constraints or stabilization devices. To better understand the effects of lateral stabilization on energy cost, we conducted a systematic review with meta-analysis of studies, which directly assessed effects of lateral stabilization on energy cost in healthy young adult participants (18-41 years old). We obtained individual participant data on net energy cost (J kg-1 m-1) from previously published studies. Across all studies reviewed, the net energy cost reduction during stabilized walking at preferred and zero step widths equaled to 0.05 {+/-} 0.35 (~2-3% reduction) and 0.25 {+/-} 0.29 J kg-1 m-1 (mean {+/-} s.d.) (~8-9% reduction), respectively. The effect of external lateral stabilization was significant only for walking at zero step width and without arm swing. Lateral stabilization devices with short rope length increased energy cost reduction. However, spring stiffness and habituation time did not influence energy cost reduction. We provide recommendations for improvement of lateral stabilization devices to avoid some of the confounding effects. External lateral stabilization reduces energy cost during walking by a small amount. It can be concluded that a small proportion of total energy cost is required to control medio-lateral stability; this proportion is larger when walking with narrow steps and without arm swing.