International Journal of Industrial Ergonomics 80 (2020) 103032

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International Journal of Industrial Ergonomics

journal homepage: http://www.elsevier.com/locate/ergon

Effect of hypoxia, safety shoe type, and lifting frequency on cardiovascular

and ventilation responses
Atef M. Ghaleb a, *, Mohamed Z. Ramadan a, Lamjed Mansour b, Jameel Al-Tamimi b,
Khalid Saad Aljaloud c
a
Department of Industrial Engineering, College of Engineering, King Saud University, Riyadh, Saudi Arabia
b
Zoology Department, College of Science, King Saud University, P.O. Box 2455, Riyadh, 11451, Saudi Arabia
c
Department of Exercise Physiology, College of Sport Sciences & Physical Activity, King Saud University, Riyadh, Saudi Arabia

A R T I C L E I N F O A B S T R A C T

Keywords: Objective: There is limited work on the physiological demands of lifting activities at different altitudes and
ECG different lifting frequencies when wearing different types of shoes. This study aimed to examine the heart rate
Heart rate variability variability (HRV) and ventilation responses of individuals in normobaric hypoxia (ambient oxygen of 15%, 18%,
Hypoxia
and 21%) while doing lifting tasks and wearing three types of different safety shoes (“light, medium, and heavy-
Manual materials handling
duty”) at two different lifting frequencies (“1 lift/min and 4 lifts/min”).
Ventilation responses
Methods: Using an experimental study design, two sessions were conducted by ten male university students that
included an acclimatization and training session followed by experimental lifting. The study used a four-way
repeated measures design (4 independent and twenty-one responses, i.e., twelve HRV and nine ventilation
responses).
Results: The findings highlighted substantial low HRV and ventilation parameters for the light workload stress in
the form of higher ambient oxygen content and lowered lifting frequency while wearing light safety shoe type. It
also presented an increase in the physical demand, followed by increased lifting frequency and replication with
increased mean heart rate and decreased mean RR, very low frequency (VLF) power, low frequency (LF) power,
and low frequency to a high-frequency ratio (LF/HF).
Conclusion: Our findings suggest that if a safe lifting load limit is applied for workers in the industrial envi­
ronment, the risk of musculoskeletal disorders will be mainly decreased, and the rate of production will be better
with ambient oxygen content and appropriate safety shoes. This research would safeguard industrial workers’
physical capacities and future health risks.

1. Introduction manual materials handling (MMH) tasks presented a significant risk.

Lifting frequency and lower back concerns are also associated with the
Most studies have confirmed that musculoskeletal disorders create a oxygen content of the air (Brocherie et al., 2017). Guo et al. (2015)
tremendous economic and human burden (Stock et al., 2014; Vos et al., reported that the oxygen content present in the atmosphere decreases as
2016). Stock et al. (2018) reported that lower back and neck pain altitude increases. These factors impact the body’s functioning as a
accounted for significant disability. Even though work-related muscu­ decrease in pressure results in a partial decline in the pressure of oxygen
loskeletal disorders are underreported in workers’ compensation claims, (Coenen et al., 2018). The atmospheric pressure alternation, along with
evidence shows that they account for 33 to 43 percent of cases (Stock the molecular pressure of oxygen, is the primary component affecting
et al., 2014, 2018; Vos et al., 2016; Safety and Board, 2013). Addi­ human respiration and oxygen transport (Guo et al., 2015). Many
tionally, ten percent of the global population is observed to experience studies have shown that the oxygen consumption and maximal work­
lower back pain during their lifetime (WSIB, 2016). Vos et al. (2016) load decrease as partial pressure of oxygen and atmospheric pressure
suggested that the involvement of weight-lifting tasks among workers’ decrease (i.e., as altitude increases) (Guo et al., 2015; Sieljacks et al.,

* Corresponding author.
E-mail addresses: [email protected] (A.M. Ghaleb), [email protected] (M.Z. Ramadan), [email protected] (L. Mansour), [email protected]
(J. Al-Tamimi), [email protected] (K.S. Aljaloud).

https://doi.org/10.1016/j.ergon.2020.103032
Received 9 September 2019; Received in revised form 15 August 2020; Accepted 7 September 2020
Available online 6 October 2020
0169-8141/© 2020 Elsevier B.V. All rights reserved.
A.M. Ghaleb et al. International Journal of Industrial Ergonomics 80 (2020) 103032

2016). Accordingly, insufficient oxygen is delivered to the cells, which different footwear types during material handling (MH). They reported
causes the interaction of hydrogen with pyruvic acid and the conversion that there is an influence of the level of friction on a perceived slipping
to lactic acid. As a result, a small degree of energy is produced through sense, energy efficiency, oxygen consumption (VO2), and maximum
temporary anaerobic metabolism. acceptable weight of holding. Kim et al. (2011) studied the character­
The accumulation of lactic acid in the tissues and blood means that istics and kinematics of the trunk and lower extremity in the sit-to-stand
there is low O2 in the mitochondria, which can be attributable to a (STS) job using electromyography (EMG) while wearing various
decrease of oxygen, lack of blood flow, or a combination of the two high-heeled shoes (1, 4, or 8 cm). The findings showed that there is a
(Hobler and Carey, 1973). This condition can lead to cell death if pro­ significant difference in EMG between the various high-heeled STS
longed. In addition, performance is measured by the amount of oxygen conditions.
that is delivered to the muscles by the circulatory system (Amann and Al-Ashaik et al. (2015) evaluated individual lifting capabilities in a
Calbet, 2008). Muscle fatigue happens during high activity because of a warm environment when wearing different safety shoe types and
lack of sufficient oxygen to enable metabolism and inorganic phosphate analyzed physiological responses (HR and muscle activity) during lift­
accumulation (Allen et al., 1995; Barry and Enoka, 2007). Earlier ing. They concluded that safety shoes affected the human body’s phys­
research findings have demonstrated that the assessment of heart rate iological responses. “The study findings demonstrated the need to
variability (HRV) can contribute substantially to the evaluation of the account for the type of safety shoes worn, which is a safety requirement
experienced problem (Bellenger et al., 2016). However, its use is by most employers when calculating the recommended weight limits.
currently limited; to date, it has only been deployed for overtraining There is a scarcity of research on the integrated impact of the discussed
prevention, physical fitness, and psychological stress (Bellenger et al., variables.” Ghaleb et al. (2019) evaluated individuals’ physiological
2016; Sassi et al., 2015). Boos et al. (2017a,b) reported on additional responses (i.e., Heart rate) while wearing different safety shoe types in
benefits of HRV, demonstrating that low cost and increasing portability hypoxia, and the results showed that the safety shoe types did not have a
have increased its use. Additionally, the assessment of the HRV follows a significant effect on the heart rate. Krings et al. (2018) assessed the in­
comprehensive evaluation that includes continuous autonomic control fluence of wearing steel-toed work boots and tactical boots on cardio­
(Sassi et al., 2015; Dong, 2016; Ramadan et al., 2019). respiratory responses and oxygen uptake (Vo2) during walking. They
Therefore, HRV can be used to perform time-based analyses with recommended that “manufacturers improve footwear design by
time intervals of 1–5 min (Bellenger et al., 2016; Wille et al., 2012). reducing footwear mass to decrease energy expenditures.”
Moreover, recent studies have also shown great interest in assessing the This study assessed the impact of oxygen content, type of safety shoe,
impact of high altitude on HRV (Boos et al., 2017a,b; Mellor et al., and lifting frequency on the HRV and ventilation responses of workers
2018), in which high altitude is defined as above 2500 m and is asso­ performing MMH tasks. Since no study has cumulatively studied HRV
ciated with oxygen content in the air of around 15% (Parati et al., 2018). and ventilation responses, this is the first to assess the impact of oxygen
A significant impact of high altitude is found on the physiological content, type of safety shoe, and lifting frequency on HRV and ventila­
exposure, showing its continuous autonomic control concerning the tion responses.
changes in the HRV (Paparde et al., 2015; Richalet, 2016).
Despite the effect of high altitude and acute hypoxia on sympathetic 2. Methods and material
activation, studies have shown that increased parasympathetic activities
lead to a decline in maximal heart rate (HR) with increasing altitude 2.1. Study design
(Paparde et al., 2015; Bellenger et al., 2016; Mazzeo and Reeves, 2003).
Various researches have shown that high altitude exposure and acute An experimental design was used to assess the effect of oxygen
hypoxia account for the HRV decline (Mellor et al., 2018). However, content, type of safety shoe, and lifting frequency on HRV and ventila­
incongruency was found regarding the association between tion responses. This design is selected since it helps obtain effective,
high-altitude symptoms and severe mountain sickness (Karinen et al., unbiased, and concrete results (Creswell and Creswell, 2017). Moreover,
2012). Additionally, research concerning HRV at high altitude is lack­ this design is effective for analyzing previous studies conducted in the
ing, as most studies have concentrated on small groups; thereby, they same domain; however, these studies consisted of different objectives,
have limited generalizability and lack application in real life (Boos et al., findings, and scope than the present study (Abadi et al., 2015).
2017a,b; Karinen et al., 2012; Huang et al., 2010). Moreover, existing
studies were performed in Iran (Abadi et al., 2015), India (Singh et al., 2.2. Study participants
2012), Malaysia (Widia et al., 2019), and Taiwan (Lee, 2009); none have
been conducted in the Saudi context. The study participants were ten male students (mean age, 26.3
Exposure to high altitude is linked to an immediately increased HR [2.53] years) enrolled at the University. Mean weight, height, shoulder
and ventilation as an outcome of hypoxemia-induced carotid chemore­ height, and hip height were 66.63 (8.04) kg, 165.1 (3.01) cm, 138.7
ceptor activation, vagal withdrawal, and sympathoexcitation (Sie­ (2.9) cm, 85.4 (3.29) cm, respectively. Mean knuckle height, knee
benmann and Lundby, 2015). This presumably occurs due to an increase height, and arm length were 67.55 (2.03) cm, 48 (2.19) cm, and 63.4
in HR as a response to inadequate oxygen content. If an individual rests (2.46) cm, respectively. The researcher obtained approval from the
at a high altitude for many days, the resting heart output normalizes “University’s institutional review board at King Saud University by
because of low stroke volume due to the plasma volume decline ac­ submitting a written copy of the study sample and procedure (E− 19-
counting for the hypoxia (Siebenmann et al., 2013). By following HR 4247)”. Written consent was also acquired to ensure the students’
and ventilation, a sustained sympathetic response results from the sus­ volunteer participation. The confidential and anonymous handling of
tained sympathetic response due to peripheral chemoreceptor activation their data was communicated. The inclusion criteria for this study were
in which persistent hypoxemia is used for sensitization (Latshang et al., as follows: (1) no history of musculoskeletal injuries; (2) no heart or
2013; Lundby et al., 2004). breathing problems; (3) live at an altitude level less than 600 m above
Rare researchers have assessed the influence of shoes during lifting sea level; and (4) no history of manual material handling.
activities. Aghazadeh and Lu (1994) assessed the effect of changing the
body position when wearing flat, 5 cm, or 7.6 cm shoes during lifting 2.3. Equipment
from floor to knuckle (F–K) and from knuckle to shoulder (K–S). Its
findings indicate that high-heeled shoes can influence on the injuries of The researcher performed the experiment in the environmental
the back and lifting. Li et al. (2007) evaluated the effect of footwear and chamber “(6 m × 6 m × 3 m) made by Weiss Technik UK LTD, Lough­
slippery floor conditions on workers who were working during wearing borough, UK. The environmental chamber features self-controlled of air

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A.M. Ghaleb et al. International Journal of Industrial Ergonomics 80 (2020) 103032

content concerning oxygen concentration, dry-bulb temperature, and develop their muscles and lifting capabilities to better represent workers
relative humidity inside the chamber, and presented all concerned data in the industrial environment. Therefore, before any data were
in a display”. For lifting, a two-handled box (“40 cm × 60 cm × 22 cm”) collected, acclimatization and training sessions were done for fourteen
was used in the experiment. To assess the worker’s electrocardiogram days (2 h every day) (Ghaleb, 2020\; Ricart et al., 2000). On the first
(ECG) and ventilation responses associated with the lifting tasks at day, the participants were trained under a moderate ambient oxygen
different altitudes, the ECG signals were recorded using an MT-ECG-1 content of 18% to become familiar with the protocol of experiment
preamplifier, “an eight-channel Biomonitor ME6000, and Mega Win before exposed to the ambient oxygen content of 15%. Thus, for the
3.0.1 software (Mega Electronics Ltd., Kuopio, Finland) at a sampling remaining 13 days, participants were exposed to 15% oxygen content
rate of 1000 Hz”. The HRV was computed using “Kubios HRV software and trained under these conditions. Once the participants were ready
(University of Western Finland, Finland)”. The ventilation responses and had acclimatized to the new conditions of environment, the
were measured using the Cortex METAMAX 3B along with the mea­ collection of data was started.
surement of HR, minute ventilation (VE), respiratory exchange ratio Under each of the 18 experimental conditions (one experimental
(RER), respiratory frequency (RF), tidal volume (VT), VO2, VO2/kg, condition per day) each participant was asked to lift from knuckle to
VO2/HR, VE/VO2, and VE/VCO2. The other components that were shoulder in 18 days with three independent variables: oxygen content
included in the study comprise of cotton squares, band-aid, 70% iso­ (“21%, 18%, and 15%”) (Ramadan et al., 2020) (Equivalent to low,
propyl alcohol swaps, “high-viscosity electrolyte gel for active elec­ moderate, and high altitudes of 0, 1500, and 2760 m above sea level,
trodes, and Ag/AgCl solid adhesive pre-gelled electrodes for ECG signal respectively) (Parati et al., 2018). As nearly 98% of the world’s popu­
acquisition (Ambu A/S, Denmark)”. Headphones were used to reduce lation lives at 2500 m or less (Moore et al., 1998), we tested lifting
the noise present in the chamber. Safety shoes manufactured by “Shel­ frequency (“1 and 4 lifts/min”) (Lee, 2005) and safety shoe type (“light,
terall Company (Italy)”, like those used in the study by Al-Ashaik et al. medium, and heavy”) (Al-Ashaik et al., 2015; Ghaleb et al., 2019).
(2015), were used in this experiment. The “eight-channel Biomonitor Previous to donning the lifting, every participant underwent the
ME6000” unit and Cortex METAMAX 3B were calibrated based on the placement of ECG electrodes on the chest, the cortex on the shoulders,
manufacture’s recommendations. and a mask on the face (Fig. 2).
Under each of the 18 experimental conditions, each participant
2.4. Experimental design and variables carried out the task of lifting inside the room. Using the freestyle pro­
cess, lifting was performed from knuckle height to shoulder height in the
The experimental analysis comprised four-way (3 × 3 × 2 × 2) sagittal plane without twisting. Participants lifted a two-handled box
repeated measures analysis of variance that was used to compute the holding weights (“40 cm × 60 cm × 22 cm”). An assistant returned the
influence of ambient oxygen content (“15%, 18%, and 21%”), lifting box to knuckle-level after raising the box to should. The participant was
frequency (“1 and 4 lifts/min”), safety shoe type (“light, medium, or allowed to do 5 min of rest pre-work, followed by 15 min of psycho­
heavy-duty”), as well as replication (first and second replication) on physical lifting to determine his maximum acceptable weight of lift
HRV and ventilation parameters. The HRV parameters were divided into (Ramadan, 1990). He kept lifting for 5 min by this maximum acceptable
different domains—mean HR, mean RR intervals (RR), standard devia­ weight of lift after a participant confirmed his maximum acceptable
tion of HR, standard deviation of RR interval, the square root of the weight of lift for the experimental session. The participant was then
mean squared differences of successive RR intervals (RMSSD), and total given 10 min to recover and rest (inside the chamber), followed by a
pairs of consecutive normalized RR intervals differing by more than 50 second lift (replication) session for other 20 min. After the second
ms in the entire recording (NN50). It also included NN50, which is a replication, the participant was granted 5 min to recover and rest. The
percentage of NN50 (pNN50), along with frequency-domain parameters difference between the two replications was in the starting given
such as absolute power of the band of frequencies <0.04 Hz (very low weights; the first replication started with 30% of the individual’s repe­
frequency [VLF]), the absolute power of the band frequencies between tition maximum, while the other replication started with no weight. The
0.04 Hz and 0.15 Hz (low frequency [LF]), the absolute power of the order was randomized for every session. During the two replications of
band of frequencies between 0.15 Hz and 0.4 Hz (high frequency [HF]), the 5-min period of lifting using the maximum acceptable lift weight, the
and the ratio of LF to HF power (LF/HF). Concerning the ventilation ECG signals and ventilation responses were measured and recorded.
parameters, the study included the respiratory frequency, HR, RER, VE,
tidal volume (VT), VO2, VO2/kg, VO2/HR, VE/VO2, and VE/VCO2. Fig. 1 2.6. Data analysis
depicts the dependent and independent study variables.
The Matlab 2015b was used to process the data, while the Statistical
2.5. Experimental procedures Package for Social Sciences (SPSS 23.0) was used to analyze the data. A
four-way repeated measures method was used with 4 independent var­
At the start of this study, participants first acclimatized to the envi­ iables. Consequently, the experiment was done 36 times that’s mean for
ronmental conditions. They were then trained on the lifting tasks to all independent variables combinations. For pairwise comparisons of the

Fig. 1. Study variables.

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3. Results

3.1. ECG responses

3.1.1. Time-domain parameters

The time-domain parameters, consisting of the five variables, were
analyzed.

3.1.1.1. Mean HR (beats/min). The two main factors, frequency of

lifting and replication and two-way interaction between replication and
frequency lifting, had significant effects on the mean HR of F (1, 9) =
30.028, p < 0.0004, ƞ2 = 0.769; F (1, 9) = 11.545, p < 0.008, ƞ2 =
0.562; F (1, 9) = 6.963, p < 0.027, ƞ2 = 0.436, respectively.
The simple effect technique was used to analyze the replication by
frequency lifting interaction. At the lifting frequency of 1 lift/min, the
HR was highly significant in the first replication than in the second
replication (p < 0.001) (Fig. 3). HR was high significant at the 4-lifts/
min frequency than at the 1-lift/min frequency (p < 0.000) (Fig. 3).

3.1.1.2. Mean RR. Mean RR was significantly affected by lifting fre­

quency, replication, and the two-way interaction between replication
and lifting frequency as F (1, 9) = 39.035, p < 0.000, ƞ2 = 0.813; F (1, 9)
= 15.932, p < 0.003, ƞ2 = 0.639; and F (1, 9) = 10.927, p < 0.009, ƞ2 =
0.548, respectively. The simple effect technique used to analyze the
replication by frequency lifting interaction. At a lifting frequency of 1
lift/min, the mean RR was significantly lower at the first replication than
at the second replication (p < 0.000) (Fig. 4). Mean RR was low sig­
nificant at the 4-lifts/min frequency than at the 1-lift/min frequency (p
< 0.000) (Fig. 4).

3.1.1.3. The standard deviation of RR interval. The main factor (lifting

Fig. 2. Experimental setup. frequency), two-way interaction between replication and lifting fre­
quency, and three-way interactions among safety shoe type, lifting fre­
quency, and replications had a significant effect on of F (1, 9) = 9.065, p
main effects, the least significant difference test was used to classify
< 0.015, ƞ2 = 0.502; F (2, 8) = 9.335, p < 0.008, ƞ2 = 0.700; and F (2, 8)
substantially different levels of the principal variables. Furthermore, if
= 15.141, p < 0.004, ƞ2 = 0.627, respectively.
an interaction had a significant effect on the dependent variables, a
Furthermore, as shown in Fig. 5a, at the first replication, the SDRR
simple effect technique was done to determine the effect of the inter­
was significantly lower at the 4-lifts/min frequency with heavy versus
action of the independent variables that have an effect on the dependent
light or medium safety shoes (p < 0.006 and p < 0.019, respectively).
variables (Keppel, 1982). “The Shapiro–Wilk test was implemented to
Furthermore, at the second replication, the SDRR was highly significant
test data normality (Shapiro and Wilk, 1965). The statistical significance
at the 4-lifts/min frequency with light than medium safety shoes (p <
was set at a confidence level of 95%”.
0.028) (Fig. 5b).

3.1.1.4. The square root of RMSSD. Only the two-way interaction

Fig. 3. Effect of replications by lifting frequency on mean heart rate.

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Fig. 4. Effect of replication by lifting frequency on mean RR intervals.

Fig. 5. Effect of safety shoe type and lifting frequency by replication on the mean standard deviation of the mean RR interval (SSDR).

between replication and lifting frequency had a significant effect on 3.1.1.5. Total number of pairs of consecutive normalized RR intervals
RMSSD (F (1, 9) = 7.917, p < 0.020, ƞ2 = 0.468). The RMSSD was differing by more than 50 ms in the entire recording (NN50). Only repli­
significantly lower at the 1-lift/min frequency at the first replication cation had a significant effect on NN50 (F (1, 9) = 7.641, p < 0.022, ƞ2
than the second replication (p < 0.001) (Fig. 6). = 0.459). The NN50 at the first replication (Mean (SD) = 39.91 (20.35))
was less significant than that at the second replication (Mean (SD) =
42.74 (20.59)).

Fig. 6. Effect of replication by lifting frequency on mean squared differences of successive RR intervals (RMSSD).

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3.1.1.6. Percentage of the total number of RR intervals. Replication, two- frequency, had a significant effect on LF/HF (F (1,9) = 25.11, p < 0.001,
way interaction between replication and lifting frequency, and three- ƞ2 = 0.736). In general, the LF/HF at a lifting frequency of 1 lift/min was
way interactions among safety shoe type, replication, and lifting fre­ high significant (mean [SD] = 6.89 [3.9]) than at lifting frequency of 4
quency had significant effect on percentage of total number of RR in­ lifts/min (3.67 [4]).
tervals (PNN50) of F (1, 9) = 7.917, p < 0.020, ƞ2 = 0.538; F (1, 9) =
7.917, p < 0.020, ƞ2 = 0.538; and F (2, 8) = 7.917, p < 0.048, ƞ2 = 3.1.2.5. Total power. The two main factors lifting frequency and repli­
0.287, respectively. cation, as well as the three-way interaction among ambient oxygen
The simple effect technique used to analyze safety shoe type by content, replication, and lifting frequency had significant effects on total
replication by lifting frequency interaction (Fig. 7). The results showed power (F (1, 9) = 13.11, p < 0.006 ƞ2 = 0.593; F (1, 9) = 6.546, p <
that at the first replication only, the PNN50 was significantly lower at 0.031, ƞ2 = 0.421; and F (2, 8) = 5.242, p < 0.035, ƞ2 = 0.567).
the 4-lifts/min frequency with heavy versus light safety shoes (p < At the first replication, the total power was highly significant at the
0.031; Fig. 7a). lifting frequency of 1 lift/min and oxygen content of 21% than at an
oxygen content of 15% (p < 0.004) (Fig. 10a).
3.1.2. Frequency domain parameters

3.2. Ventilation responses

3.1.2.1. Very low-frequency power. The results show that VLF power
was affected by lifting frequency (F (1, 9) = 15.04, p < 0.004, ƞ2 =
3.2.1. Respiratory frequency
0.626) and the three-way interaction among ambient oxygen content,
Only the main variable, lifting frequency, had a significant effect on
replication and lifting frequency, (F (1, 9) = 4.958, p < 0.019, ƞ2 =
the RF (F (1,9) = 82.526, p < 0.001, ƞ2 = 0.902). In general, the RF at
0.355).
the lifting frequency of 1 lift/min was low significant (23.43 [2.43])
At the first replication, the VLF power was significantly higher at the
than that at the lifting frequency of 4 lifts/min (30.232 [4.05]).
lifting frequency of 1 lift/min and oxygen content of 21% than at an
oxygen content of 15% (p < 0.019) (Fig. 8a). In addition, the VLF was
3.2.2. Minute ventilation
high significant at the 1-lift/min frequency than the 4-lifts/min fre­
The two main variables, and replication, F (1,9) = 19.62, p < 0.02, ƞ2
quency for both replications (p < 0.000 and p < 0.000, respectively)
= 0.685, and lifting frequency, F (1,9) = 104.140, p < 0.001, ƞ2 = 0.920
(Fig. 8a and b).
had significant effect on VE. The VE was high significant at the lifting
frequency of 4 lifts/min (25.675 [4.43]) than at 1 lift/min (16.242
3.1.2.2. Low-frequency power. The two main variables, replication (F
[2.13]). Moreover, the VE was significantly higher at the second repli­
(1,9) = 8.408, p < 0.018, ƞ2 = 0.483) and lifting frequency (F (1,9) =
cation (21.09 [3.14]) versus the first replication (20.82 [3.17]).
16.705, p < 0.003, ƞ2 = 0.650) had significant effects on LF power. The
LF power was high significant at the lifting frequency of 1 lift/min
3.2.3. Respiratory exchange ratio
(mean (SD) = 1936.44 (803.2)) than at the frequency of 4 lifts/min
RER was significantly affected by ambient oxygen content, replica­
(mean (SD) = 843.80 (398.4)). Moreover, the LF was high significant at
tion, lifting frequency, two-way interaction between replication and
the second replication (mean (SD) = 1460.78 (480.5)) than at the first
lifting frequency, and three-way interactions among ambient oxygen
replication (mean (SD) = 1319.46 (483.8)).
content, frequency of lifting, and safety shoe (F (1,9) = 19.84, p < 0.002,
ƞ2 = 0.688; F (1,9) = 21.31, p < 0.02, ƞ2 = 0.703; F (1,9) = 23.19, p <
3.1.2.3. High-frequency power. The statistical results showed that the 0.001, ƞ2 = 0.720; F (4,6) = 4.608, p < 0.048, ƞ2 = 0.754, respectively).
high frequency (HF) power was significantly affected by replication as The simple effect technique was used to analyze the replication by
well as the three-way interaction among ambient oxygen content, frequency lifting interaction. The results showed that at lifting frequency
replication and safety shoe type (F (1,9) = 5.878, p < 0.038, ƞ2 = 0.395 of 1 lift/min, the RER was low significant at the first versus the second
and F (4,6) = 8.793, p < 0.02, ƞ2 = 0.854, respectively). replication (p < 0.000) (Fig. 11).
Fig. 9b shows that, for the second replication, HF power was highly When the lifting frequency was 4 lifts/min and the oxygen content
significant at an ambient oxygen content of 21% with medium versus was 18%, the RER was significantly higher with medium versus light
light or heavy safety shoes (p < 0.019 and p < 0.013, respectively). Also, safety shoes (p < 0.007) or heavy safety shoes (p < 0.001). The RER was
the HF power was highly significant at an ambient oxygen content of significantly higher with light safety shoes than with heavy safety shoes
15% with light versus heavy or medium safety shoes (p < 0.034 and p < (p < 0.047) (Fig. 12b).
0.023, respectively). When the lifting frequency was 1 lift/min and oxygen content was
18%, the RER was significantly lower with medium safety shoes than
3.1.2.4. The ratio of LF to HF power. Only the main variable, lifting with light safety shoes (p < 0.021) (Fig. 12a).

Fig. 7. Effect of safety shoe type by lifting frequency by replication on the percentage of the total number of RR intervals (PNN50).

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Fig. 8. Effect of ambient oxygen content by replication by lifting frequency on very low frequency (VLF) power.

Fig. 9. Effect of ambient oxygen content by safety shoe type by replication on high frequency (HF) power.

Fig. 10. Effect of ambient oxygen content by replication by lifting frequency on the total power.

3.2.4. Tidal volume 3.2.6. VO2/kg

Only the main variable, lifting frequency, had a significant effect on The results show that VO2/kg was affected by lifting frequency (F (1,
VT (F (1,9) = 88.662, p < 0.001, ƞ2 = 0.908). In general, the VT at a 9) = 104.502, p < 0.001, ƞ2 = 0.921), the two-way interaction between
lifting frequency of 1 lift/min was low significant (0.697 [0.08]) than replication and safety shoe type (F (2,8) = 6.921, p < 0.018, ƞ2 = 0.634),
that at a lifting frequency of 4 lifts/min (0.851 [0.09]). and the three-way interactions among ambient oxygen content, repli­
cation, and lifting frequency (F (2,8) = 5.288, p < 0.034, ƞ2 = 0.569).
3.2.5. VO2 At the second replication, the VO2/kg was highly significant at the
The statistical results showed that VO2 was significantly affected by lifting frequency of 4 lifts/min and oxygen content of 21% than at an
lifting frequency and the three-way interactions among ambient oxygen oxygen content of 15% (p < 0.026) or 18% (p < 0.019) (Fig. 14).
content, replication, and lifting frequency (F (1,9) = 134.403, p < 0.001,
ƞ2 = 0.937; F (1,9) = 7.38, p < 0.015, ƞ2 = 0.649, respectively). 3.2.7. VO2/HR
The results showed that, at the second replication, VO2 was signifi­ VO2/HR was affected by lifting frequency (F (1, 9) = 103.604, p <
cantly higher at the lifting frequency of 4 lifts/min and oxygen content 0.001, ƞ2 = 0.902) and the three-way interactions among ambient ox­
of 21% than that at an oxygen content of 15% (p < 0.017) (Fig. 13). ygen content, replication, and lifting frequency (F (2,8) = 5.525, p <

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A.M. Ghaleb et al. International Journal of Industrial Ergonomics 80 (2020) 103032

Fig. 11. Effect of replication by lifting frequency on respiratory exchange ratio (RER).

Fig. 12. Effect of lifting frequency by ambient oxygen content by safety shoe type on respiratory exchange ratio (RER).

0.031, ƞ2 = 0.580). replication. The results are consistent with those reported by Al-Alshaik
At the second replication, VO2/HR was highly significant at the et al. (2015). The outcomes also demonstrated that the lower SDRR was
lifting frequency of 4 lifts/min and oxygen content of 21% than that at linked with an increase in lifting frequencies. Also, the SDRR was lower
an oxygen content of 18% (p < 0.046) (Fig. 15). significant at first replication when lifting frequency of four lifts/min
with heavy versus light or medium safety shoes. In addition, at the
3.2.8. The ratio of VE to VO2 second replication, the SDRR was higher significant at the four lifts/min
Only the main variable, ambient oxygen content, had a significant frequency with light when compared to medium safety shoes.
effect on VE/VO2 (F (1,9) = 4.76, p < 0.043, ƞ2 = 0.543). In general, the Furthermore, the RMSSD was low at the first replication when the
VE/VO2 at oxygen content of 18% was high significant (29.103 [2.5]) frequency was one lift/min when compared to the second replication. As
than that at an oxygen content of 21% (27.42 [2.66]). well as, the PNN50 was low at a lifting frequency four lifts/min at the
first replication with heavy versus light or medium safety shoes. Even­
4. Discussion tually, a lower HF power was linked with the second replication, and
when medium safety shoes were being worn at an oxygen content of
This study examined the functions of cardiovascular autonomy re­ 15%.
sponses associated with performing the lifting task. Those responses Heart rate variability (HRV) is dependent on autonomic balance,
were evaluated in different ambient oxygen levels, lifting frequencies, specifically, a decrease in the parasympathetic (or an increase in the
and safety shoe types during two replications. The HRV indicated sympathetic) tone that decreases variability; though an increase in the
increasing HR and decreasing RR as lifting rates increased at the first parasympathetic (or decrease in the sympathetic) tone that increases

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A.M. Ghaleb et al. International Journal of Industrial Ergonomics 80 (2020) 103032

Fig. 13. Effect of ambient oxygen content by replication by lifting frequency on oxygen uptake (VO2).

Fig. 14. Effect of ambient oxygen content by replication by lifting frequency on oxygen consumption per kilogram (VO2/kg).

Fig. 15. Effect of ambient oxygen content by replication by lifting frequency on the ratio of oxygen consumption to heart rate (VO2/HR).

variability. The main findings of this research represented by HRV re­ et al., 2004) or prolonged exposure to different stressors (Collins et al.,
sponses, i.e., LF, HF, the LF/HF ratio, are sensitive indicators of physical 2005) or. The physical demand increased as lifting frequency increased
demands agree with various studies using either short-term (Hjortskov as well as the ambient oxygen content decreased. The findings were

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A.M. Ghaleb et al. International Journal of Industrial Ergonomics 80 (2020) 103032

established in terms of an increase in mean HR and a lowered mean RR, equation uses metabolic cost (Waters et al., 1993, 1994), which is usu­
VLF, LF/HF ratio, and LF power as the physical demand increased. ally measured as a function of metabolic response to a given task based
Moreover, the lifting frequency (4 lifts/min) caused a significant in­ on variables such as heart rate, oxygen uptake, and caloric cost
crease in autonomic activities with the first replication. These results are (American College of Sports Medicine, 2018; Borg, 1982). Caloric cost
similar to those of earlier studies (Vuksanović and Gal, 2007; Paritala, (kcal/min) is calculated from the use of oxygen (O2) during a task using
2009; Abadi et al., 2015). a statistical equation where kcal/min is equal to O2 usage per minute
High Frequency (HF) power shows the effect of respiration on HR multiplied by 5 kcal (kcal/min = O2/min = 5 kcal) (American College of
and indicates parasympathetic activity (Vuksanovic and Gal, 2007), And Sports Medicine, 2018). “NIOSH has set task-specific kcal/min limits (e.
respiratory sinus arrhythmia is characterized (Kamath and Fallen, g., 33–50 percent maximum) for lifting tasks of different durations (e.g.,
1993). Extremely regular modulation of the parasympathy results in an 0–8 h) to reduce metabolic stress and fatigue arising from a given work
increased HR (Vuksanovic and Gal, 2007). That is definitely what activity” (Waters et al., 1993). “During these exercises, the energy cost
occurred at the physical activity. The variable High Frequency (HF) ranged from 6 to 8 kcal/min with fuel form as measured by the RER
increased more during the physical activity as the respiratory pattern ranging from mixed fuel (i.e., fat and carbohydrate) to higher intensity
changed due to the increase in lifting frequency. Contrary to the higher and greater use of carbohydrate as fuel (i.e., 0.86 to 0.95 RERs) “(Sevene
values of the low-frequency component for improving the physical de­ et al., 2019). Also, in Knott et al. (2015), it has been proposed that a
mands, the low-frequency component decreased during the steady-state higher duration of load can result in more significant results for RER.
effort (Pagani et al., 1986). Still, the exact explanations for the decline Since an increase in lifting frequency requires more significant effort
are unknown. The current results of this research are justified as the and higher oxygen requirements in the human muscular system, during
physical task planned since it can be described as a psychophysical test the increased energy, more oxygen is consumed as HR increases, which
stay. The findings of this study showed that the subjects worked under a gives direction for the other responses of ventilation and thus increases
significant amount of physiological stress, which is apparent from the the breathing process. Another possible limitation has lacked the control
high level of working HR. The HRV of the participants showed the strong for lifting techniques for participants, overall lifting performance, or
influence of increasing lifting frequency. The HRV was influenced by physical differences that would influence the cost of oxygen during
factors such as lifting the load and respiratory rate (Ravenswaaij et al., lifting tasks (Sharp et al., 1988).
1993). Therefore, the weight lifted by the workers during lifting tasks Additionally, the VE and the RER were higher in the first than the
must be safe to facilitate their HRV being in the low to a medium second replication, where the mechanical and metabolic costs of pre­
category of risk. The HR assessed during the exercises was influenced by serving sufficient ventilation during activity can be essential and in­
the focus on upper or lower body lifting and the isometric aspect of this crease exponentially as a function of VE (Dominelli et al., 2015).
weight transfer (e.g., grabbing and keeping in place). This illustrates the Furthermore, during the lifting experiment, RF was remarkably lower
effect of muscle contraction and tension on HR and the risk of using HR under the condition of a light workload at lower oxygen content in the
alone to quantify the strength of lifting activities (American College of first replication with light-duty safety shoes. In exercise physiology, FR
Sports Medicine, 2018). And, an increase in HR can be due to increased is sometimes measured as one of the two VE components (together with
recruitment of motor units for the heavy load’s move (Fry, 2004). And, VT). VE has, however, traditionally provided much more attention than
there is HR’s linear relation to work intensity (American College of its components, becoming the best single predictor of ventilation effi­
Sports Medicine, 2018). ciency. Nevertheless, recent research indicates that during exercise FR
In terms of metabolic parameters, the present study clearly demon­ and VT are controlled by specific inputs and that their differential re­
strated the relationship between energy systems and the physical effort sponses contain useful information (Nicolò et al., 2017a, b). FR plays a
demands in different ambient oxygen content (partial oxygen pressure at significant role as a clear marker of physical activity during exercise,
15%, 18%, and 21%). At sea level (O2 partial pressure 21%), energy more so than other commonly controlled physiological variables (Nicolò
system, energy expenditure, and other metabolic variables such as res­ et al., 2017c).
piratory parameters affected by physical activity levels (McArdle et al., The VO2 was remarkably decreased at the lower oxygen level (15%)
2010). These changes in the metabolic parameters have been found to be and in the second replication with the lower lifting frequency, where one
different at high altitudes (i.e. 2500 m above sea level) (Parati et al., of the most essential and ideally suited parameters for stress analysis is
2018). Particularly, oxygen supply to working muscles will be relatively oxygen consumption (Rühle, 2008). Participants reached about 64% of
less at high altitudes comparing to the sea level at a certain given their predicted HRmax (obtained from, HRmax = 205.8–0.685 (age)
physical activity level. (Inbar et al., 1994)) which is equivalent to ~ 64% of their VO2max at 4
Therefore, the outcomes of the measures of ventilation disclosed that lifts/min compared to the 1 lift/min (~50 of their predicted VO2max) in
a lower RER is related to increased ambient oxygen and lowered lifting both replications, which explains the reduction in mean RR intervals at 4
frequency, where the RER is the ratio between the amount of carbon lifts/min in both replications. Some untrained individuals, their body
dioxide (CO2) produced in metabolism and oxygen (O2) consumed may start to use anaerobic energy resources which in turn leads to an
(Schmidt-Nielsen, 1997); that’s mean the RER increased as the workload increase in the blood lactate concentration (AghiliNasab, 2017). In such
increased. Physiologically, increasing in the RER value means that body cases, working at high altitudes (i.e. ~ 2500m above sea level) should
tissue (mainly skeletomuscular tissue) starts to depend on the anaerobic consider the energy metabolic system in order to develop workers’
energy system. Consequently, ventilation parameters elevate to elimi­ performance and their productivity. Additionally, VE/VO2 decreased as
nate the consequences of oxygen deficiency including the interaction of the oxygen content increased. Also, Ohyabu et al. (1990) demonstrated
hydrogen with pyruvic acid and the conversion to lactic acid (Hobler that with training, ventilatory sensitivity during hypoxia was reduced.
and Carey, 1973). As a result, the rising workload may be explained by Endurance training effectively decreases the ventilatory response to a
decreased ambient oxygen and increased the lifting frequency; and the given level of work due to reduced chemo-sensitivity (McConnell and
results of this study are similar to previous studies results (Xu et al., Semple, 1996; Katayama et al., 1999).
2005; Farinatti et al., 2016; Ghaleb et al., 2020). Similarly, when the
first replication was compared with the second replication, RER was low 5. Conclusion
during the first replication when the lifting frequency was 1 lift/min.
Furthermore, the lifting frequency impacts the responses of ventilation, The results of the analysis revealed that increased physical demand
where RER, RF, VT, VE, VO2, VO2/kg, and VO2/HR increased with the (i.e, increase in lifting frequency, or decrease in the ambient oxygen
increase in lifting frequency that is means increased in the work stress. content) significantly increased mean HR and decreased mean RR, LF/
As a predictor of physiological work stress, the updated NIOSH lifting HF ratio, VLF, and LF powers. As well as, the physical demand effects on

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A.M. Ghaleb et al. International Journal of Industrial Ergonomics 80 (2020) 103032

the ventilation responses, where RER, RF, VT, VE, VO2, VO2/kg, and Aghazadeh, F., Lu, H., 1994. Relationship between posture and lifting capacity. Intl. J.
Industr. Erg. 13, 353–356.
VO2/HR increased with the increase in physical demand. Additionally,
AghiliNasab, H., 2017. The effect of acute and chronic moderate and high intensity
this study aimed to show scientific evidence indicating the importance aerobic exercise on serum nitric oxide in untrained overweight males. Jentashapir J.
of cardiovascular and ventilation responses during lifting tasks. We also Health Res. 8 (3), .
offered guidance on how to interpret and describe cardiovascular and Al-Ashaik, R.A., Ramadan, M.Z., Al-Saleh, K.S., Khalaf, T.M., 2015. Effect of safety shoes
type, lifting frequency, and ambient temperature on subject’s MAWL and
ventilation data at different levels of oxygen content environments, physiological responses. Intl. J. Industr. Erg. 50, 43–51.
types of safety shoes, and frequency of lifting. This study directs the Allen, D.G., Lannergren, J., Westerblad, H., 1995. Muscle cell function during prolonged
importance of considering different altitudes for the supervision of the activity: cellular mechanisms of fatigue. Exp. Physiol. Transl. Integr. 80 (4),
497–527.
lifters and who works in the field of applied research in MMH tasks. Also, Amann, M., Calbet, J.A., 2008. Convective oxygen transport and fatigue. J. Appl. Physiol.
Our results indicate that when a safe lifting load for industrial workers is 104 (3), 861–870.
implemented, the risk of musculoskeletal disorders will be largely American College of Sports Medicine, 2018. ACSM’s Guidelines for Exercise Testing and
Prescription. Lippincott Wolters Kluwer, Philadelphia (PA).
reduced, and the production rate will be improved with considering Barry, B.K., Enoka, R.M., 2007. The neurobiology of muscle fatigue: 15 years later.
ambient oxygen content and appropriate safety shoes. This study safe­ Integr. Comp. Biol. 47 (4), 465–473.
guards the physical capacities of factory workers and potential safety Bellenger, C.R., Fuller, J.T., Thomson, R.L., Davison, K., Robertson, E.Y., Buckley, J.D.,
2016. Monitoring athletic training status through autonomic heart rate regulation: a
risks. Moreover, this study issued the importance of wearing proper systematic review and meta-analysis. Sports Med. 46, 1461–1486.
safety shoes during MMH tasks. The findings agreed with those of pre­ Boos, C.J., Bakker-Dyos, J., Watchorn, J., Woods, D.R., O’Hara, J.P., Macconnachie, L.,
vious studies such as Krings et al. (2018), That recommended that Mellor, A., 2017a. A comparison of two methods of heart rate variability assessment
at high altitude. Clin. Physiol. Funct. Imaging 37, 582–587.
manufacturers improve the quality of the footwear by reducing footwear
Boos, C., Vincent, E., Mellor, A., O Hara, J., Newman, C., Cruttenden, R., et al., 2017b.
mass to reduce energy costs, and Al-Ashaik et al. (2015), which pointed The effect of sex on heart rate variability at high altitude. Med. Sci. Sports Exerc. 49,
out the importance of wearing safety shoes while performing MMH 2562–2569.
activities. Borg, G.A., 1982. Psychophysical bases of perceived exertion. Med. Sci. Sports Exerc.
Brocherie, F., Girard, O., Faiss, R., Millet, G.P., 2017. Effects of repeated-sprint training
in hypoxia on sea-level performance: a meta-analysis. Sports Med. 47, 1651–1660.
6. Future work Coenen, P., Korshøj, M., Hallman, D.M., Huysmans, M.A., van der Beek, A.J., Straker, L.
M., Holtermann, A., 2018. Differences in heart rate reserve of similar physical
activities during work and in leisure time–A study among Danish blue-collar
Though manual lifting tasks under hypoxia are commonly found in workers. Physiol. Behav. 186, 45–51.
high-altitude cities when wearing various types of safety shoes. In this Collins, S.M., Karasek, R.A., Costas, K., 2005. Job strain and autonomic indices of
cardiovascular disease risk. Am. J. Industr. Med. 48, 182–193.
area the literature revealed a definite lack of information. For future
Creswell, J.W., Creswell, J.D., 2017. Research Design: Qualitative, Quantitative, and
studies, we give the following suggestions: Mixed Methods Approaches. Sage publications.
Dominelli, P.B., Render, J.N., Molgat-Seon, Y., Foster, G.E., Romer, L.M., Sheel, A.W.,
1. Study the worker’s lifting capabilities under hypoxia when wearing 2015. Oxygen cost of exercise hyperpnoea is greater in women compared with men.
J. Physiol. 593 (8), 1965–1979.
various types of safety shoes using different job variables values Dong, J.G., 2016. The role of heart rate variability in sports physiology. Exper. Therap.
other than those evaluated in this study. Med. 11, 1531–1536.
2. Study the manual materials handling activities in more hypoxia. Farinatti, P., NETO, A.G.C., Amorim, P.R., 2016. Oxygen consumption and substrate
utilization during and after resistance exercises performed with different muscle
3. Use machine learning to study the effect of hypoxia while wearing mass. Int. J. Exerc. Sci. 9 (1), 77.
different types of safety shoes on the lifting capabilities of Fry, A.C., 2004. The role of resistance exercise intensity on muscle fibre adaptations.
individuals. Sports Med. 34 (10), 663–679.
Ghaleb, A.M., Ramadan, M.Z., Badwelan, A., Saad Aljaloud, K., 2019. Effect of ambient
oxygen content, safety shoe type, and lifting frequency on subject’s MAWL and
CRediT authorship contribution statement physiological responses. Intl. J. Environ. Res. Pub. Health. 16, 4172.
Ghaleb, et al., 2020. Determining the time needed for workers to acclimatize to hypoxia.
International Journal of Biometeorology. https://doi.org/10.1007/s00484-02
Atef M. Ghaleb: Conceptualization, Methodology, Software, Vali­ 0-01989-8.
dation, Formal analysis, Investigation, Writing - original draft, Visuali­ Ghaleb, A.M., Khalaf, T.M., Ramadan, M.Z., Ragab, A.E., Badwelan, A., 2020. Effect of
zation. Mohamed Z. Ramadan: Conceptualization, Methodology, cycling on a stationary bike while performing assembly tasks on human physiology
and performance parameters. Int. J. Environ. Res. Publ. Health 17 (5), 1761.
Software, Formal analysis, Investigation, Resources, Writing - original Guo, C., Xu, J., Wang, M., Yan, T., Yang, L., Sun, Z., 2015. Study on oxygen supply
draft, Writing - review & editing, Visualization, Supervision. Lamjed standard for physical health of construction personnel of high-altitude tunnels. Intl.
Mansour: Software, Formal analysis, Writing - review & editing. J. Environ. Res. Pub. Health 13, 64.
Hjortskov, N., Rissén, D., Blangsted, A.K., Fallentin, N., Lundberg, U., Søgaard, K., 2004.
Jameel Al-Tamimi: Validation, Formal analysis, Writing - review & The effect of mental stress on heart rate variability and blood pressure during
editing. Khalid Saad Aljaloud: Methodology, Software, Investigation, computer work. Eur. J. Appl. Physiol. 92, 84–89.
Resources, Supervision. Hobler, K.E., Carey, L.C., 1973. Effect of acute progressive hypoxemia on cardiac output
and plasma excess lactate. Ann. Surg. 177 (2), 199.
Huang, H.H., Tseng, C.Y., Fan, J.S., Yen, D.H.T., Kao, W.F., Chang, S.C., et al., 2010.
Alternations of heart rate variability at lower altitude in the predication of trekkers
Declaration of competing interest
with acute mountain sickness at high altitude. Clin. J. Sport Med. 20, 58–63.
Inbar, O.M.R.I., Oren, A., Scheinowitz, M.I.C.K.E.Y., Rotstein, A.R.I.E., Dlin, R.O.N.A.L.
The authors declare that they have no known competing financial D., Casaburi, R.I.C.H.A.R.D., 1994. Normal cardiopulmonary responses during
interests or personal relationships that could have appeared to influence incremental exercise in 20-to 70-yr-old men. Med. Sci. Sports Exerc. 26, 538-538.
Kamath, M.V., Fallen, E.L., 1993. Power spectral analysis of heart rate variability: a
the work reported in this paper. noninvasive signature of cardiac autonomic function. Crit. Rev. Biomed. Eng. 21 (3),
245–311.
Karinen, H.M., Uusitalo, A., Vähä-Ypyä, H., Kähönen, M., Peltonen, J.E., Stein, P.K.,
Acknowledgments et al., 2012. Heart rate variability changes at 2400 m altitude predicts acute
mountain sickness on further ascent at 3000–4300 m altitudes. Frontiers. Physiol. 3,
This work was supported by the Research Supporting Project 336.
Katayama, K., Sato, Y., Morotome, Y., Shima, N., Ishida, K., Mori, S., Miyamura, M.,
(RSP2020/75), King Saud University, Riyadh, Saudi Arabia.
1999. Ventilatory chemosensitive adaptations to intermittent hypoxic exposure with
endurance training and detraining. J. Appl. Physiol. 86 (6), 1805–1811.
References Keppel, G., 1982. Design and Analysis: A Researcher’s Handbook, second ed. Prentice-
Hall, Inc., Englewood Cliffs.
Kim, M.H., Chung, H.Y., Yoo, W.G., Choi, B.R., 2011. EMG and kinematics analysis of the
Abadi, A.S.S., Mazlomi, A., Saraji, G.N., Zeraati, H., Hadian, M.R., Jafari, A.H., 2015.
trunk and lower extremity during the sit-to-stand task while wearing shoes with
Effects of box size, frequency of lifting, and height of lift on maximum acceptable
different heel heights in healthy young women. Hum. Mov. Sci. 30, 596–605.
weight of lift and heart rate for male university students in Iran. Electron. Physician
7, 1365.

11
A.M. Ghaleb et al. International Journal of Industrial Ergonomics 80 (2020) 103032

Knott, V.C., Mayr, T., Bengler, K., 2015. Lifting activities in production and logistics of Ramadan, M.Z., Ghaleb, A.M., Ragab, A.E., 2020. Using electroencephalography (EEG)
the future–Cardiopulmonary Exercise Testing (CPET) for analyzing physiological power responses to investigate the effects of ambient oxygen content, safety shoe
stress. Procedia Manufact. 3, 354–362. type, and lifting frequency on the worker’s activities. BioMed Res. Int. 2020.
Krings, B.M., Miller, B.L., Chander, H., Waldman, H.S., Knight, A.C., McAllister, M.J., Ricart, A., Casas, H., Casas, M., Pagés, T., Palacios, L., Rama, R., et al., 2000.
Fountain, B.J., Smith, J.W., 2018. Impact of occupational footwear during simulated Acclimatization near home? Early respiratory changes after short-term intermittent
workloads on energy expenditure. Footwear Sci. 10, 157–165. https://doi.org/ exposure to simulated altitude. Wilder. Environ. Med. 11, 84–88.
10.1080/19424280.2018.1460623. Richalet, J.P., 2016. Physiological and clinical implications of adrenergic pathways at
Latshang, T.D., Turk, A.J., Hess, T., Schoch, O.D., Bosch, M.M., Barthelmes, D., et al., high altitude. In: Hypoxia. Springer, Boston, pp. 343–356.
2013. Acclimatization improves submaximal exercise economy at 5533 m. Scand. J. Rühle, K.H., 2008. Praxisleitfaden der Spiroergometrie. W. Kohlhammer Verlag, .
Med. Sci. Sports 23, 458–467. Safety, W., Board, I., 2013. By the Numbers: 2012 WSIB Statistical Report. Schedule 1.
Lee, T.H., 2005. Psychophysically determined asymmetrical lifting capabilities for Sassi, R., Cerutti, S., Lombardi, F., Malik, M., Huikuri, H.V., Peng, C.K., et al., 2015.
different frequencies and containers. Ind. Health 43, 337–340. Advances in heart rate variability signal analysis: joint position statement by the e-
Lee, T.H., 2009. Maximum symmetric and asymmetric isoinertial lifting capabilities from cardiology ESC working group and the European heart rhythm association co-
floor to knuckle height. Ind. Health 47, 635–639. endorsed by the asia pacific heart rhythm society. Ep. Europace. 17, 1341–1353.
Li, K.W., Yu, R.F., Han, X.L., 2007. Physiological and psychophysical responses in Sevene, T.G., DeBeliso, M., Harris, C., Berning, J., Climstein, M., Adams, K.J., 2019.
handling maximum acceptable weights under different footwear–floor friction Cardiovascular and Psychophysical Response to Repetitive Lifting Tasks in Women.
conditions. Appl. Erg. 38, 259–265. J. Lifestyle Med. 9 (2), 125.
Lundby, C., Calbet, J.A., van Hall, G., Saltin, B., Sander, M., 2004. Pulmonary gas Shapiro, S.S., Wilk, M.B., 1965. An analysis of variance test for normality (complete
exchange at maximal exercise in Danish lowlanders during 8 wk of acclimatization samples). Biometrika 52, 591–611.
to 4,100 m and in high-altitude Aymara natives. Am. J. Physiol. Integr. Comparat. Sharp, M.A., Harman, E., Vogel, J.A., Knapik, J.J., Legg, S.J., 1988. Maximal aerobic
Physiol. 287, R1202–R1208. capacity for repetitive lifting: comparison with three standard exercise testing
Mazzeo, R.S., Reeves, J.T., 2003. Adrenergic contribution during acclimatization to high modes. Eur. J. Appl. Physiol. Occup. Physiol. 57 (6), 753–760.
altitude: perspectives from Pikes Peak. Exer. Sport. Sci. Rev. 31, 13–18. Siebenmann, C., Lundby, C., 2015. Regulation of cardiac output in hypoxia. Scand. J.
McArdle, W.D., Katch, F.I., Katch, V.L., 2010. Exercise Physiology: Nutrition, Energy, and Med. Sci. Sports 25, 53–59.
Human Performance, sixth ed. Lippincott Williams & Wilkins, pp. 189–194. Siebenmann, C., Hug, M., Keiser, S., Müller, A., van Lieshout, J., Rasmussen, P.,
McConnell, A.K., Semple, E.S., 1996. Ventilatory sensitivity to carbon dioxide: the Lundby, C., 2013. Hypovolemia explains the reduced stroke volume at altitude.
influence of exercise and athleticism. Med. Sci. Sports Exerc. 28 (6), 685–691. Physiol. Rep. 1.
Mellor, A., Bakker-Dyos, J., O’Hara, J., Woods, D.R., Holdsworth, D.A., Boos, C.J., 2018. Sieljacks, P., Thams, L., Nellemann, B., Larsen, M.S., Vissing, K., Christensen, B., 2016.
Smartphone-enabled heart rate variability and acute mountain sickness. Clin. J. Comparative effects of aerobic training and erythropoietin on oxygen uptake in
Sport Med. 28, 76–81. untrained humans. J. Strength Condit Res. 30, 2307–2317.
Moore, L.G., Niermeyer, S., Zamudio, S., 1998. Human adaptation to high altitude: Singh, J., Kalra, P., Walia, R., 2012. Study of maximum acceptable weight of lift for
regional and life-cycle perspectives. Am. J. Physiol. Anthropol. 107, 25–64. Indian male industrial workers. Intl. J. Engineer. Res. Tech. 1, 2181–2278.
Nicolò, A., Girardi, M., Sacchetti, M., 2017a. Control of the depth and rate of breathing: Stock, S., Nicolakakis, N., Raïq, H., Messing, K., Lippel, K., Turcot, A., 2014.
metabolic vs. non-metabolic inputs. J. Physiol. 595, 6363–6364. https://doi.org/ Underreporting work absences for nontraumatic work-related musculoskeletal
10.1113/JP275013. disorders to workers’ compensation: results of a 2007–2008 survey of the Quebec
Nicolò, A., Marcora, S.M., Bazzucchi, I., Sacchetti, M., 2017b. Differential Control of working population. Am. J. Publ. Health 104, e94–e101.
Respiratory Frequency and Tidal Volume during High. Stock, S.R., Nicolakakis, N., Vezina, M., Vezina, N., Gilbert, L., Turcot, A., et al., 2018.
Nicolò, A., Massaroni, C., Passfield, L., 2017c. Respiratory frequency during exercise: the Are work organization interventions effective in preventing or reducing work-related
neglected physiological measure. Front. Physiol. 8, 922. musculoskeletal disorders? A systematic review of the literature. Scand. J. Work
Ohyabu, Y., Usami, A., Ohyabu, I., Ishida, Y., Miyagawa, C., Arai, T., Honda, Y., 1990. Environ. Health 44 (2), 113–133.
Ventilatory and heart rate chemosensitivity in track-and-field athletes. Eur. J. Appl. Van Ravenswaaij-Arts, C.M.A., Kollee, L.A.A., Hopman, J.C.W., et al., 1993. Heart rate
Physiol. Occup. Physiol. 59 (6), 460–464. variability. Ann. Intern. Med. 118, 436–447. https://doi.org/10.7326/0003-4819-
Pagani, M., Lombardi, F., Guzzetti, S., Rimoldi, O., Furlan, R., Pizzinelli, P., Sandrone, G., 118-6-199303150-00008.
Malfatto, G., Dell’Orto, S., Piccaluga, E., Turiel, M., Baselli, G., Cerutti, S., Vos, T., Allen, C., Arora, M., Barber, R.M., Bhutta, Z.A., Brown, A., et al., 2016. Global,
Malliani, A., 1986. Power spectral analysis of heart rate and arterial pressure regional, and national incidence, prevalence, and years lived with disability for 310
variabilities as a marker of sympatho-vagal interaction in man and conscious dog. diseases and injuries, 1990–2015: a systematic analysis for the Global Burden of
Circ. Res. 59, 178–193. Disease Study 2015. Lancet 388, 1545–1602.
Paparde, A., Plakane, L., Circenis, K., Aivars, J.I., 2015. Effect of acute systemic hypoxia Vuksanović, V., Gal, V., 2007. Heart rate variability in mental stress aloud. Med. Eng.
on human cutaneous microcirculation and endothelial, sympathetic and myogenic Phys. 29, 344–349.
activity. Microvasc. Res. 102, 1–5. Waters, T.R., Putz-Anderson, V., Garg, A., Fine, L.J., 1993. Revised NIOSH equation for
Parati, G., Agostoni, P., Basnyat, B., Bilo, G., Brugger, H., Coca, A., et al., 2018. Clinical the design and evaluation of manual lifting tasks. Ergonomics 36, 749–776.
recommendations for high altitude exposure of individuals with pre-existing Waters, T.R., Putz-Anderson, V., Garg, A., 1994. Applications Manual for the Revised
cardiovascular conditions: a joint statement by the European society of cardiology, NIOSH Lifting Equation. U.S. Department of Health and Human Services, National
the council on hypertension of the European society of cardiology, the European Institute for Occupational Safety and Health. Cincinnati (OH).
society of hypertension, the international society of mountain medicine, the Italian Widia, M., Dawal, S.Z.M., Yusoff, N., 2019. Maximum acceptable frequency of lift for
society of hypertension and the Italian society of mountain medicine. Eur. Heart J. combined manual material handling task in Malaysia. PloS One 14, e0216918.
39, 1546–1554. Wille, M., Mairer, K., Gatterer, H., Philippe, M., Faulhaber, M., Burtscher, M., 2012.
Paritala, S.A., 2009. Effects of Physical and Mental Tasks on Heart Rate Variability. Changes in cardiac autonomic activity during a passive 8-hour acute exposure to 5
Master of Science thesis. The Department of Construction Management & Industrial 500 m normobaric hypoxia are not related to the development of acute mountain
Engineering, Louisiana State University. sickness. Intl. J. Sports. Med. 33, 186–191.
Ramadan, M., Nasr, M., Dabwan, A., Khalaf, T., Alhaag, M., Soliman, A., Abdelgawad, A., Workplace Safety and Insurance Board of Ontario, 2016. WSIB by the numbers 2016. htt
2019. Evaluation of holding handheld scanner on muscle activity, heart rate p://www.wsib.on.ca.
variability, and model accuracy in industrial applications. Intl. J. Industr. Erg. 74, Xu, G.D., Liu, M., Chen, G., Gong, H., Luo, Q.M., 2005. Relationship between respiration
102873. https://doi.org/10.1016/j.ergon.2019.102873. exchange ratio and muscle oxygen content measured by near-infrared spectroscopy.
Ramadan, M.Z., 1990. Effects of task and environment-related variables on individuals’ Hang Tian Yi Xue Yu Yi Xue Gong Cheng= Space Med. Med. Eng. 18 (1), 28–31.
lifting capabilities while wearing protective clothing (Ph.D. West Virginia
University, Morgantown, West Virginia.

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