Date of Award

August 2023

Degree Type


Degree Name

Doctor of Philosophy


Health Sciences

First Advisor

Jennifer Earl-Boehm

Committee Members

Hayley Ericksen, Wendy Huddleston, Monna Arvinen-Borrow, Razia Azen


gait retraining, music, running-related injury, step-rate alteration


Context: Running-related injury (RRI) is a significant public health issue that may be caused by injurious running biomechanics. Increasing step-rate (SR) using gait retraining may prevent and treat RRI. The Optimizing Performance Through Intrinsic Motivation and Attention for Learning (OPTIMAL) theory indicates enhanced expectancies, autonomy, and external focus of attention will optimize motor learning. Music has been shown to create enhanced expectancies, can provide incidental choices (autonomy), directs attention externally, and may increase compliance. No studies have investigated if music can be used to alter SR and running biomechanics or strategies that may improve compliance to gait retraining. Objective: The purpose of this study was to 1) compare differences in SR and running biomechanics between those who use music auditory cueing (MUS) and those who use metronome auditory cueing (MET) during the phases of a temporospatial gait retraining protocol, 2) compare differences in RPE change scores across four temporospatial gait retraining sessions between the MUS and MET group, and 3) determine if there is an association between groups (MUS and MET) and compliance to a self-administered, temporospatial gait retraining protocol and describe the likelihood of compliance between groups (MUS and MET).

Methods: Thirty, healthy recreational runners were included and randomly placed in either the MET or MUS group. Inertial measurement unit motion analysis collected SR, peak positive tibial acceleration (PPA), and peak stance phase hip adduction (peakHIPADD) during the stance phase of running. A cellular device application collected running volume and SR data when participants ran outside of the lab, which defined compliance. The Borg’s rate of perceived exertion (RPE) scale was used to compare change in RPE between groups. A multivariate repeated measures ANOVA was used to compare SR, PPA, and peakHIPADD from the introductory pretest (INTROpre) and the three posttests (INTROpost, LABpost, SELFpost). Change scores between baseline RPE and RPE after each gait retraining session were calculated and analyzed using a mixed repeated measures ANOVA. SR and running volume were derived from the cellular application exports and compliance was defined as 1) maintaining an average SR within +/- two steps per minute of the target SR throughout each run and 2) maintaining the average running volume. Runners were assigned as “compliant” and “noncompliant”. A Fischer’s exact test was performed, and an odds ratio was calculated to determine association and likelihood of compliance between groups. Results: Both groups increased SR between the INTROpre and introductory posttest (INTROpost) (p <.001), and the increase in SR was maintained at all other posttest timepoints (LABpost and SELFpost). There were no differences in PPA or peakHIPADD at any posttest timepoints regardless of group. No significant differences in RPE change scores between groups across time were found. There was a significant association between group and compliance (p = .05) and the MUS group was ~6 times as likely to comply with the self-administered gait retraining program.

Conclusions: SR can be altered using either a metronome or music tempo. Both a metronome and music can be used as an auditory cue without creating increased perception of exertion. Runners using the music auditory cueing may continue to practice their new target SR more than runners assigned a metronome cueing, which provides rationale to use music to retrain SR within a self-administered gait retraining protocol. Running biomechanics may not have changed since SR was only increased by 5% so future research should repeat the current study methods using larger increases in SR.