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The developed model predicts local endosteal and periosteal cortical accretion and resorption based on relative local and global measures of the tibial stress state and its surface variation. Using a multisegment 3\u2010dimensional leg model, tibia shape adaptations due to 33 combinations of hip, knee, and ankle joint angles and the direction of a single or sequential series of generated isometric resultant forces were predicted. The maximum stress at a common fracture\u2010prone region in each optimized geometry was compared under likely stress fracture\u2010inducing midstance jogging conditions. No direct correlations were found between stress reductions over an initially uniform circular hollow cylindrical geometry under these critical design conditions and the exercise\u2010based sets of active muscles, joint angles, or individual muscle force and local stress magnitudes. Additionally, typically favorable increases in cross\u2010sectional geometric measures did not guarantee stress decreases at these locations. Instead, tibial stress distributions under the exercise conditions best predicted strengthening ability. Exercises producing larger anterior distal stresses created optimized tibia shapes that better resisted the high midstance jogging bending stresses. Bent leg configurations generating anteriorly directed or inferiorly directed resultant forces created favorable adaptations. None of the studied loads produced by a straight leg was significantly advantageous. These predictions and the insight gained can provide preliminary guidance in the screening and development of targeted bone strengthening techniques for those susceptible to distal tibial stress fractures.<\/jats:p>","DOI":"10.1002\/cnm.2976","type":"journal-article","created":{"date-parts":[[2018,3,6]],"date-time":"2018-03-06T01:22:42Z","timestamp":1520299362000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Effectiveness of various isometric exercises at improving bone strength in cortical regions prone to distal tibial stress fractures"],"prefix":"10.1002","volume":"34","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0669-5769","authenticated-orcid":false,"given":"C.S.","family":"Florio","sequence":"first","affiliation":[{"name":"Department of Mechanical and Industrial Engineering New Jersey Institute of Technology  University Heights Newark NJ 07102 USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2018,4,15]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.3109\/17453677809005718"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.pmrj.2015.09.019"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.1002\/jbmr.5650110512"},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.1177\/1941738116677732"},{"key":"e_1_2_7_6_1","doi-asserted-by":"publisher","DOI":"10.1136\/bjsm.34.3.195"},{"key":"e_1_2_7_7_1","doi-asserted-by":"publisher","DOI":"10.2214\/ajr.149.2.329"},{"key":"e_1_2_7_8_1","doi-asserted-by":"publisher","DOI":"10.1093\/rheumatology\/35.9.905"},{"key":"e_1_2_7_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.bone.2012.07.019"},{"key":"e_1_2_7_10_1","doi-asserted-by":"publisher","DOI":"10.1097\/00005768-199908000-00002"},{"key":"e_1_2_7_11_1","first-page":"216","article-title":"Analysis of biomechanical mechanisms of tibial stress fractures among Israeli infantry recruits","volume":"231","author":"Milgrom C","year":"1998","journal-title":"Clin Orthop Relat Res"},{"key":"e_1_2_7_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.bone.2008.10.044"},{"key":"e_1_2_7_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.clinbiomech.2015.07.012"},{"key":"e_1_2_7_14_1","doi-asserted-by":"publisher","DOI":"10.1249\/00003677-199700250-00009"},{"key":"e_1_2_7_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.gaitpost.2009.10.009"},{"key":"e_1_2_7_16_1","doi-asserted-by":"publisher","DOI":"10.1249\/MSS.0b013e31817571ae"},{"key":"e_1_2_7_17_1","doi-asserted-by":"publisher","DOI":"10.1016\/0021-9290(89)90226-1"},{"key":"e_1_2_7_18_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.pmrj.2014.09.017"},{"key":"e_1_2_7_19_1","doi-asserted-by":"publisher","DOI":"10.1359\/jbmr.080805"},{"key":"e_1_2_7_20_1","doi-asserted-by":"publisher","DOI":"10.1152\/japplphysiol.01468.2010"},{"key":"e_1_2_7_21_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00776-003-0671-5"},{"key":"e_1_2_7_22_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.clinbiomech.2016.02.013"},{"key":"e_1_2_7_23_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12891-017-1481-9"},{"key":"e_1_2_7_24_1","doi-asserted-by":"publisher","DOI":"10.5312\/wjo.v4.i4.267"},{"key":"e_1_2_7_25_1","doi-asserted-by":"crossref","unstructured":"MansorNN DaudR BasaruddinKSet al.Review of biomechanical modeling of cortical bone stress fractures.Proceedings of the 2nd International Conference on Biomedical Engineering (ICoBE 2015). 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