Induction of labor with Foley catheter and risk of subsequent preterm birth: follow-up study of two randomized controlled trials (PROBAAT-1 and -2).

OBJECTIVE: To evaluate the rate of preterm birth (PTB) in a subsequent pregnancy in women who had undergone term induction using a Foley catheter compared with prostaglandins. METHODS: This was a follow-up study of two large randomized controlled trials (PROBAAT-1 and PROBAAT-2). In the original trials, women with a term singleton pregnancy with the fetus in cephalic presentation and with an indication for labor induction were randomized to receive either a 30-mL Foley catheter or prostaglandins (vaginal prostaglandin E2 in PROBAAT-1 and oral misoprostol in PROBAAT-2). Data on subsequent ongoing pregnancies > 16 weeks' gestation were collected from hospital charts from clinics participating in this follow-up study. The main outcome measure was preterm birth < 37 weeks' gestation in a subsequent pregnancy. RESULTS: Fourteen hospitals agreed to participate in this follow-up study. Of the 1142 eligible women, 572 had been allocated to induction of labor using a Foley catheter and 570 to induction of labor using prostaglandins. Of these, 162 (14%) were lost to follow-up. In total, 251 and 258 women had a known subsequent pregnancy > 16 weeks' gestation in the Foley catheter and prostaglandin groups, respectively. There were no differences in baseline characteristics between the groups. The overall rate of PTB in a subsequent pregnancy was 9/251 (3.6%) in the Foley catheter group vs 10/258 (3.9%) in the prostaglandin group (relative risk (RR), 0.93; 95% CI, 0.38-2.24), and the rate of spontaneous PTB was 5/251 (2.0%) vs 5/258 (1.9%) (RR, 1.03; 95% CI, 0.30-3.51). CONCLUSION: In women with term singleton pregnancy, induction of labor using a 30-mL Foley catheter is not associated with an increased risk of PTB in a subsequent pregnancy, as compared to induction of labor using prostaglandins. © 2020 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

Effect of maternal diabetes on fetal heart function on echocardiography: systematic review and meta-analysis.

OBJECTIVE: Maternal diabetes in pregnancy is associated with structural anomalies of the fetal heart, as well as hypertrophy and functional impairment. This systematic review and meta-analysis aimed to estimate the effect of maternal diabetes on fetal cardiac function as measured by prenatal echocardiography. METHODS: We performed a search of the EMBASE, PubMed and The Cochrane Library databases, from inception to 4 July 2019, for studies evaluating fetal cardiac function using echocardiography in pregnancies affected by diabetes compared with uncomplicated pregnancies. Outcome measures were cardiac hypertrophy and diastolic, systolic and overall cardiac function as assessed by various ultrasound parameters. The quality of the studies was assessed using the Newcastle-Ottawa Scale. Data on interventricular septal (IVS) thickness, myocardial performance index (MPI) and E/A ratio were pooled for the meta-analysis using random-effects models. For pregnancies with diabetes, results were reported overall and according to whether diabetes was pregestational (PDM) or gestational (GDM). Results were also stratified according to the trimester in which fetal cardiac assessment was performed. RESULTS: Thirty-nine studies were included, comprising data for 2276 controls and 1925 women with pregnancy affected by diabetes mellitus (DM). Of these, 1120 had GDM, 671 had PDM and in 134 cases diabetes type was not specified. Fetal cardiac hypertrophy was more prevalent in diabetic pregnancies than in non-diabetic controls in 21/26 studies, and impaired diastolic function was observed in diabetic pregnancies in 22/28 studies. The association between DM and systolic function was inconsistent, with 10/25 studies reporting no difference between cases and controls, although more recent studies measuring cardiac deformation, i.e. strain, did show decreased systolic function in diabetic pregnancies. Of the studies measuring overall fetal cardiac function, the majority (14/21) found significant impairment in diabetic pregnancies. Results were similar when stratified according to GDM or PDM. These effects were already present in the first trimester, but were most profound in the third trimester. Meta-analysis of studies performed in the third trimester showed, compared with controls, increased IVS thickness in both PDM (mean difference, 0.75 mm (95% CI, 0.56-0.94 mm)) and GDM (mean difference, 0.65 mm (95% CI, 0.39-0.91 mm)) pregnancies, decreased E/A ratio in PDM pregnancies (mean difference, -0.09 (95% CI, -0.15 to -0.03)), no difference in E/A ratio in GDM pregnancies (mean difference, -0.01 (95% CI, -0.02 to 0.01)) and no difference in MPI in either PDM (mean difference, 0.04 (95% CI, -0.01 to 0.09)) or GDM (mean difference, 0.03 (95% CI, -0.01 to 0.06)) pregnancies. CONCLUSIONS: The findings of this review show that maternal diabetes is associated with fetal cardiac hypertrophy, diastolic dysfunction and overall impaired myocardial performance on prenatal ultrasound, irrespective of whether diabetes is pregestational or gestational. Further studies are needed to demonstrate the relationship with long-term outcomes. © 2020 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

Monitoring core temperature of firefighters to validate a wearable non-invasive core thermometer in different types of protective clothing: Concurrent in-vivo validation.

This study aims (1) to test the validity of a new non-invasive core thermometer, Cosinuss°, in rest and (2) during firefighting simulation tasks, against invasive temperature pill and inner-ear temperature and (3) to compare the change in core temperature of firefighters when working in two types of protective clothing (traditional turnout gear versus new concept). 11 active firefighters performed twice a selection of tasks during their periodic preventive medical examination and a fire-extinguishing task. Without correction no correlation between the Cosinuss° and thermometer pill (ICC≤0.09, p ≥ 0.154, LoA≥1.37) and a moderate correlation between Cosinuss° and inner-ear infrared (ICC = 0.40, p = 0.044, LoA±1.20) was observed. With individual correction both correlations were excellent (ICC≥0.84, p = 0.000, LoA≤0.30). However, during and after working all correlations were poor and non-significant (ICC≤0.38, p ≥ 0.091, LoA≥1.71). During firefighting tasks, the Cosinuss° is invalid for measuring the core temperature. No differences in heat development in the two types of protective clothing was proven.

Automatic extraction of the intracranial volume in fetal and neonatal MR scans using convolutional neural networks.

MR images of infants and fetuses allow non-invasive analysis of the brain. Quantitative analysis of brain development requires automatic brain tissue segmentation that is typically preceded by segmentation of the intracranial volume (ICV). Fast changes in the size and morphology of the developing brain, motion artifacts, and large variation in the field of view make ICV segmentation a challenging task. We propose an automatic method for segmentation of the ICV in fetal and neonatal MRI scans. The method was developed and tested with a diverse set of scans regarding image acquisition parameters (i.e. field strength, image acquisition plane, image resolution), infant age (23-45 weeks post menstrual age), and pathology (posthaemorrhagic ventricular dilatation, stroke, asphyxia, and Down syndrome). The results demonstrate that the method achieves accurate segmentation with a Dice coefficient (DC) ranging from 0.98 to 0.99 in neonatal and fetal scans regardless of image acquisition parameters or patient characteristics. Hence, the algorithm provides a generic tool for segmentation of the ICV that may be used as a preprocessing step for brain tissue segmentation in fetal and neonatal brain MR scans.

Automatic brain tissue segmentation in fetal MRI using convolutional neural networks.

MR images of fetuses allow clinicians to detect brain abnormalities in an early stage of development. The cornerstone of volumetric and morphologic analysis in fetal MRI is segmentation of the fetal brain into different tissue classes. Manual segmentation is cumbersome and time consuming, hence automatic segmentation could substantially simplify the procedure. However, automatic brain tissue segmentation in these scans is challenging owing to artifacts including intensity inhomogeneity, caused in particular by spontaneous fetal movements during the scan. Unlike methods that estimate the bias field to remove intensity inhomogeneity as a preprocessing step to segmentation, we propose to perform segmentation using a convolutional neural network that exploits images with synthetically introduced intensity inhomogeneity as data augmentation. The method first uses a CNN to extract the intracranial volume. Thereafter, another CNN with the same architecture is employed to segment the extracted volume into seven brain tissue classes: cerebellum, basal ganglia and thalami, ventricular cerebrospinal fluid, white matter, brain stem, cortical gray matter and extracerebral cerebrospinal fluid. To make the method applicable to slices showing intensity inhomogeneity artifacts, the training data was augmented by applying a combination of linear gradients with random offsets and orientations to image slices without artifacts. To evaluate the performance of the method, Dice coefficient (DC) and Mean surface distance (MSD) per tissue class were computed between automatic and manual expert annotations. When the training data was enriched by simulated intensity inhomogeneity artifacts, the average achieved DC over all tissue classes and images increased from 0.77 to 0.88, and MSD decreased from 0.78 mm to 0.37 mm. These results demonstrate that the proposed approach can potentially replace or complement preprocessing steps, such as bias field corrections, and thereby improve the segmentation performance.

Brain and CSF Volumes in Fetuses and Neonates with Antenatal Diagnosis of Critical Congenital Heart Disease: A Longitudinal MRI Study.

BACKGROUND AND PURPOSE: Fetuses and neonates with critical congenital heart disease are at risk of delayed brain development and neurodevelopmental impairments. Our aim was to investigate the association between fetal and neonatal brain volumes and neonatal brain injury in a longitudinally scanned cohort with an antenatal diagnosis of critical congenital heart disease and to relate fetal and neonatal brain volumes to postmenstrual age and type of congenital heart disease. MATERIALS AND METHODS: This was a prospective, longitudinal study including 61 neonates with critical congenital heart disease undergoing surgery with cardiopulmonary bypass <30 days after birth and MR imaging of the brain; antenatally (33 weeks postmenstrual age), neonatal preoperatively (first week), and postoperatively (7 days postoperatively). Twenty-six had 3 MR imaging scans; 61 had at least 1 fetal and/or neonatal MR imaging scan. Volumes (cubic centimeters) were calculated for total brain volume, unmyelinated white matter, cortical gray matter, cerebellum, extracerebral CSF, and ventricular CSF. MR images were reviewed for ischemic brain injury. RESULTS: Total fetal brain volume, cortical gray matter, and unmyelinated white matter positively correlated with preoperative neonatal total brain volume, cortical gray matter, and unmyelinated white matter (r = 0.5-0.58); fetal ventricular CSF and extracerebral CSF correlated with neonatal ventricular CSF and extracerebral CSF (r = 0.64 and 0.82). Fetal cortical gray matter, unmyelinated white matter, and the cerebellum were negatively correlated with neonatal ischemic injury (r = -0.46 to -0.41); fetal extracerebral CSF and ventricular CSF were positively correlated with neonatal ischemic injury (r = 0.40 and 0.23). Unmyelinated white matter:total brain volume ratio decreased with increasing postmenstrual age, with a parallel increase of cortical gray matter:total brain volume and cerebellum:total brain volume. Fetal ventricular CSF:intracranial volume and extracerebral CSF:intracranial volume ratios decreased with increasing postmenstrual age; however, neonatal ventricular CSF:intracranial volume and extracerebral CSF:intracranial volume ratios increased with postmenstrual age. CONCLUSIONS: This study reveals that fetal brain volumes relate to neonatal brain volumes in critical congenital heart disease, with a negative correlation between fetal brain volumes and neonatal ischemic injury. Fetal brain imaging has the potential to provide early neurologic biomarkers.

Antenatal corticosteroid therapy: short-term effects on fetal behaviour and haemodynamics.

Antenatal corticosteroid therapy to enhance fetal lung maturity in threatened preterm delivery has a number of non-pulmonary side-effects, both beneficial and undesirable. This review focuses on the short-term (transient) effects of betamethasone and dexamethasone on aspects of fetal circulation and behaviour which are used clinically as markers of fetal well-being. We summarise the effects observed, discuss the proposed underlying mechanisms, and emphasise the consequences for clinical decision-making. Recommendations are given to optimise medical care and to minimise the risk of unwarranted iatrogenic preterm delivery.

[At the limits of viability: Dutch referral policy for premature birth too reserved]. / Op de grens van levensvatbaarheid: Nederlands verwijsbeleid bij vroeggeboorte te terughoudend.

OBJECTIVE: Evaluation of policy and treatment of deliveries at the limits of viability in the Netherlands and resulting survival figures. DESIGN: Cohort study. METHOD: Within the framework of the European 'Models of organising access to intensive care for very preterm births in Europe' (MOSAIC) study, data was collected on all 512 births in 2003 (terminations excluded) following 22-31 weeks gestation in the catchment areas of the perinatal centres in Nijmegen and Utrecht, the Netherlands. RESULTS: Gynaecologists and neonatologists practised a reserved policy for the active treatment of pregnancies under 25 weeks (5/77; 6%); all infants died. At 25 weeks, an active obstetric policy was used in one quarter of pregnancies, but none of the infants survived. Even at 26 weeks pregnancy, the obstetric policy was reserved and the mortality relatively high (9/31; 29%). From the neonatal deaths, 86 out of 92 (93%) were preceded by a decision either not to start or to discontinue treatment. CONCLUSION: Dutch obstetricians and neonatologists practised a reserved policy at the limits of neonatal viability. There is more need for active antenatal transfer to perinatal centres for those at the lower limit of neonatal viability to enable well-balanced decisions to take place. The parents' wishes should always be taken into account.

Positive pressure breathing during rest and exercise.

The requirements to maintain a positive pressure with respiratory protection during heavy exercise and the effects on ventilation and feelings of discomfort were investigated. Eight male subjects participated, using the respirator system during rest and exercise at about 80% of their individual maximum power. A blower was used at maximum and medium capacity and at two pressure levels (3 and 15 mbar). Additionally, the mouth pressure was used as a feedback for the blower. The blower decreased the fraction of the breathing cycle with negative pressures from 50% (SD 4%) to 15% (SD 10%) during exercise. Negative pressures occurred at all settings of the blower during exercise. Thus, the currently available commercial blower systems do not supply a sufficient airflow to maintain a positive pressure during heavy exercise. Positive pressure breathing did not affect the ventilation and the circulation. But the oxygen consumption was higher with the blower and respirator than without.

Maximal oxygen uptake during cycling is reduced in moving environments; consequences for motion-induced fatigue.

In previous studies on physical fatigue during simulated ship movements, the apparent exhaustion of subjects after experimentation suggested that the traditional index of physical workload, oxygen consumption expressed as the percentage of peak oxygen consumption (VO2-peak) measured in a separate graded exercise test (GXT), underestimates workload in a moving environment. In these studies, the GXT was carried out in a stationary environment, as is standard practice. To explain the underestimation, it was hypothesized that VO2-peak might have been less if the GXT had been carried out in the moving environment. This paper reports on three experimental tests of this hypothesis, performed with a ship motion simulator and aboard a ship at sea. In all three experiments, VO2-peak was indeed significantly reduced when the GXT was carried out in the moving environment. Theoretical reasons for this phenomenon are discussed and investigated, but a clear explanation is still lacking.

Changes in the synaptology of spinal motoneurons in zebrafish following spinal cord transection.

Effects of spinal cord transection on the synaptology of zebrafish spinal motoneurons were studied. The transection was made at the level of the 14th vertebra and the synaptology of motoneuron somata and dendrites was analysed at the level of the 21st to the 23rd vertebrae at one month and three months after transection. Horseradish peroxidase, applied to the myotomal muscle, was used to label motoneuron somata and dendritic branches in central and in lateral areas of the neuropil (referred to as central and lateral dendritic profiles). Boutons impinging on motoneurons were classified according to the morphology of the vesicles. We discerned R-boutons with spherical vesicles, F-boutons with flat vesicles and DC-boutons with at least one dense core vesicle. The apposition lengths of R-, F- and DC-boutons and the circumference of labelled profiles were determined to assess the proportional covering of boutons on somata and dendrites. Ratio's of covering with R- and F-boutons (R/F ratio) for somata, central and lateral dendritic profiles were 1.1, 2.1, and 2.1 in control fish and 0.5, 0.5 and 0.9 in lesioned fish at one month after transection, respectively. The total covering of motoneurons in lesioned fish was decreased by 20% on somata and by 30% on lateral dendritic profiles, whereas central dendritic profiles did not change significantly. At three months after transection the R/F ratio's for somata, central and lateral dendritic profiles were 0.5, 0.7 and 0.6, respectively. The total covering on somata and central and lateral dendritic profiles was at control levels. The anatomical aspects of the changes in synaptology indicate that in control fish 50 to 60% of the R-boutons on the motoneuron surface originate from descending axons. In contrast, almost all F-boutons seem to be from local origin.

Human energy expenditure when walking on a moving platform.

The assumption that working on board ship is more strenuous than comparable work ashore was investigated in this study. Various physiological parameters (VO2, VCO2, VE and HR) have been measured to determine the energy expenditure of subjects walking slowly on a moving platform (ship motion simulator). Twelve subjects (eight men and four women) walked either freely on the floor or on a treadmill at a speed of 1 m x s(-1). Platform motion was either in a heave, pitch or roll mode. These three conditions were compared with a control condition in which the platform remained stationary. The results showed that during pitch and roll movements of the platform, the energy expenditure for the same walking task was about 30% higher than under the stationary control condition (3.6 J x kg[-1] x m[-1] vs 2.5 J x kg[-1] x m[-1], P < 0.05) for both walking on a treadmill and free walking. The heart rate data supported the higher energy expenditure results with an elevation of the heart rate (112 beats x min[-1] vs 103 beats x min[-1], P < 0.05). The heave condition did not differ significantly from the stationary control condition. Pitch and roll were not significantly different from each other. During all experimental conditions free walking resulted in a higher energy cost of walking than treadmill walking (3.5 J x kg[-1] x m[-1] vs 2.7 J x kg[-1] x m[-1], P < 0.05) at the same average speed. The results of this experiment were interpreted as indicating that the muscular effort, needed for maintaining balance when walking on a pitching or rolling platform, resulted in a significantly higher work load than similar walking on a stable or a heaving floor, independent of the mode of walking. These results explain in part the increased fatigue observed when a task is performed on a moving platform.

Changes in enzyme histochemical profiles of identified spinal motoneurons of the European eel, Anguilla anguilla, following cordotomy.

The enzyme histochemical profiles of glucose-6-phosphate dehydrogenase (a marker of synthetic performance), succinate dehydrogenase (an indicator of oxidative metabolism), and NADH tetrazolium reductase (a marker of overall neuronal activity) were determined for identified white muscle motoneurons in six control and six cordotomized cels. Images were digitized and mean integrated absorbances obtained using appropriate hardware and software. For motoneurons caudal to the transection site there was a significant decrease in the mean absorbance value for NADH tetrazolium reductases which declines from 0.28 a.u. (arbitrary units) in control animals to 0.23 a.u. in cordotomized animals. However, no significant changes were detected in the activities of glucose-6-phosphate and succinate dehydrogenases. The cross-sectional area of the motoneuronal cell body was not affected by cordotomy. The decrease by around 20% in overall neuronal activity, as expressed by NADH tetrazolium reductase activity, might be expected from the decline in body motility that follows cordotomy. Changes in SDH and G6PDH activities would also be expected to follow this surgery, but none were seen, perhaps because they are compensated for by changes in neuronal metabolism that result from deafferentation.

Physiological criteria for functioning of hands in the cold: a review.

Hands are important instruments in daily life. Without hands man is hardly able to function independently. Proper functioning of the hands is determined by several physiological parameters. These physiological parameters in turn are influenced by environmental factors. In this view of the literature, physiological processes in manual dexterity are described and the influence of a cold environment on separate physiological processes is studied. In general, cold means loss of dexterity. For reasons of safety and performance, it is important to restrict the loss of manual dexterity. For this purpose, in this study minimum criteria are given for all separate physiological components. Most important minimum criteria are: a local skin temperature of 15 degrees C, a nerve temperature of 20 degrees C and a muscle temperature of 28 degrees C. Only during maximum dynamic work is a muscle temperature of 38 degrees C recommended. These temperatures are average values, and of course individual differences are evident.

The hand in the cold, performance and risk.

When a person is exposed to cold and his metabolic rate is insufficient to maintain a positive or neutral heat balance, the body will cool down. For the extremities this will result in a drastic reduction of blood flow, resulting in a so called "physiological amputation" with extremity cooling towards ambient temperature. The dexterity decrease observed with cold extremities is most likely caused by cooling of muscles and joints, and not by effects on receptors, nerve conduction or central effects. It is shown, that dexterity decreases can be described in terms of wind chill equivalent temperature and exposure time for a certain clothing and work configuration. Further, the risk of skin freezing and reduced dexterity due to touching cold objects can be described using the contact coefficient of the respective material and the contact time. This risk is modulated by metabolic rate and hand protection (gloves). Gloves drastically reduce cooling speed and freezing risk, but they also cause increased risks due to reduced dexterity due to glove thickness. For a general description of performance and risk of hand cold exposure in relation to climate and exposure time more data are needed.

The use of texture analysis for the discrimination of Nissl substance in neurons.

Structural changes induced by cordotomy in the Nissl substance of identifiable spinal motoneurons innervating the white musculature of the European eel were quantified with the use of texture features calculated from digitized images. Data were evaluated and the motoneurons classified by using multivariate analysis. The study shows that there are differences in the structural organization of the Nissl substance of motoneurons taken from control and cordotomized fishes. Distinction could only be made by using texture features, as visual examination of the motoneurons did not reveal any alteration of the studied cellular substance. Reorganization of the Nissl substance might be the result of a changed protein metabolism or a changed neuronal activity pattern consequent upon cordotomy. The method employs quick and simple techniques and could be useful in several other neurobiological studies.

Effects of temperature on electromyogram and muscle function.

The effects of 30 min of cooling (15 degrees C water) and warming (40 degrees C water) on arm muscle function were measured. A reference condition (24 degrees C air) was included. Of nine young male subjects the maximal grip force (Fmax), the time to reach 66% of Fmax (rate of force buildup) and the maximal rhythmic grip frequency were determined, together with surface electromyographic activity (EMG) of a forearm muscle (flexor digitorum superficialis). The results showed that in contrast to warming, cooling resulted in a significant decrease of 20% in the Fmax and a significant 50% decrease in force build-up time and the maximal rhythmic grip frequency. The relationship between the root mean square value (rms) of the EMG and the static grip force did not change due to temperature changes. The median power frequency (MPF) in the power spectrum of the EMG signal decreased by 50% due to cooling but remained unchanged with heating. During a sustained contraction at 15% of Fmax (Fmax depending on the temperature) the increase in the rms value with contraction time was 90% larger in the warm condition and 80% smaller in the cold condition compared to the increase in the reference condition. The MPF value remained constant during the warm and reference conditions but in the cold it started at a 50% lower value and increased with contraction time.(ABSTRACT TRUNCATED AT 250 WORDS)

Pain, thermal sensation and cooling rates of hands while touching cold materials.

Hand cooling and resulting comfort and pain were studied in 12 subjects, while touching six different materials (polyurethane foam, wood, nylon, rustproof steel, aluminium, and temperature-controlled metal) which were initially at ambient temperature. This was done for three ambient temperatures (-10 degrees, 0 degree and 10 degrees C), after pre-exposure exercise or rest, with bare hands or while wearing gloves. The observed cooling curves were analysed as Newtonian cooling curves. The observed time constants appeared to be significantly related to the materials' contact coefficients, the presence of hand protection, the preceding activity, and the interaction between contact coefficient and the presence of hand protection. These parameters also allowed a good description of the time constant (r2 = 0.8) of the related cooling curves. Thermal and pain sensation could be described in terms of the local skin temperature, ambient temperature and hand protection. Equal pain and thermal levels were associated with lower temperatures of the back of the hand than of the contact side. The slightly painful condition was associated with a skin temperature of 16 degrees C for the back and 19 degrees C for the palm of the hand. The pain level appeared to be inversely related to cooling speed. Skin freezing occurred at higher skin temperatures when touching cold objects than when exposed to cold air as a result of reduced supercooling. The regression equations determined allowed calculations to be made of safety limits for hand cooling while in contact with a wide range of materials.

Physiological strain due to load carrying in heavy footwear.

To determine the effects of wearing heavy footwear on physiological responses five male and five female subjects were measured while walking on a treadmill (4, 5.25, and 6.5 km.h-1) with different external loads (barefooted, combat boots, and waist pack). While walking without an external load the oxygen uptake, as a percentage of maximal oxygen uptake (%VO2max) of the men increased from 25% VO2max at 4 km.h-1 to 31% VO2max at 5.25 km.h-1 and to 42% VO2max at 6.5 km.h-1. The women had a significantly higher oxygen uptake of 30%, 40%, and 55% VO2max, respectively. In the most strenuous condition, walking at 6.5 km.h-1 with combat boots and waist pack (12 kg), the oxygen uptake for the men and women amounted to 53% and 75% VO2max, respectively. The heart rate showed a similar response to the oxygen uptake, the women having a heart rate which was 15-40 beats.min-1 higher than that of the men, depending on the experimental condition. The perceived exertion was shown to be greatly dependent on the oxygen uptake. From the results a regression formula was calculated predicting the oxygen uptake depending on the mass of the footwear, walking speed and body mass. It was concluded that the mass of footwear resulted in an increase in the energy expenditure which was a factor 1.9-4.7 times greater than that of a kilogram of body mass, depending on sex and walking speed.