An interdisciplinary examination of attentional focus strategies used during running gait retraining

The aim was to investigate the biomechanical, physiological, and perceptual responses to different motor learning strategies derived to elicit a flatter foot contact. Twenty-eight rearfoot-striking recreational runners (age 24.9 ± 2.8 years; body mass 78.8 ± 13.6 kg; height 1.79 ± 0.09 m) were matched by age, mass, and height and assigned to one verbal cue group: internal focus of attention (IF), external focus of attention (EF), and a clinically derived condition (CLIN) incorporating an IF followed by an EF statement. Participants completed two treadmill runs at 10 km h^-1 for 6 minutes each: normal running (control) followed by the experimental condition (IF, EF, or CLIN). Lower limb kinematics, oxygen consumption ( $$ ), and central and peripheral ratings of perceived exertion (RPE) were recorded for each run. Compared to the control condition, foot angle was reduced in the IF (difference = 5.86°, d = 2.58) and CLIN (difference = 3.00°, d = 1.31) conditions, but unchanged in the EF condition (difference = 0.33°, d = 0.14), while greater knee flexion at initial contact in the EF and CLIN conditions was observed (difference = -5.19°, d = 1.97; difference = -3.66°, d = 1.39, respectively). A higher $$ was observed in the CLIN condition (difference = -4.56 mL kg^-1  min^-1 , d = 2.29), but unchanged in the IF (difference = -1.87 mL kg^-1  min^-1 , d = 0.94) and EF conditions (difference = -0.37 mL kg^-1  min^-1 , d = 0.19). All experimental conditions increased central and peripheral RPE (difference = -1.08, d = 0.54 and difference = -2.39, d = 1.33, respectively). Providing gait retraining instructions using an internally directed focus of attention was the most effective way to target specific changes in running kinematics, with no detrimental effect on physiological responses. Yet, perceptual effort responses increased regardless of the type of cue provided.