Excess Body Weight and Gait Influence Energy Cost of Walking in Older Adults

Purpose: To study how excess body weight influences the energy cost of walking (Cw) and determine if overweight and obese older adults self-select stride frequency to minimize Cw. Methods: Using body mass index (BMI) men and women between the ages of 65–80 yr were separated into normal weight (NW, BMI ≤ 24.9 kg m−2, n = 13) and overweight-obese groups (OWOB, BMI ≥25.0 kg m−2, n = 13). Subjects walked at 0.83 m s−1 on an instrumented treadmill that recorded gait parameters, and completed three, six-minute walking trials; at preferred stride frequency (PSF), at +10% PSF, and at −10% PSF. Cw was determined by indirect calorimetry. Repeated measures analysis of variance was used to compare groups, and associations were tested with Pearson correlations, α = 0.05. Results: OWOB had 62% greater absolute Cw (301 ± 108 vs. 186 ± 104 J m−1, P \u3c 0.001) and 20% greater relative Cwkg (3.48 ± 0.95 vs. 2.91 ± 0.94 J kg−1 m−1, P = 0.046) than NW. Although PSF was not different between OWOB and NW (P = 0.626), Cw was 8% greater in OWOB at +10% PSF (P \u3c 0.001). At PSF OWOB spent less time in single-limb support (33.1 ± 1.5 vs. 34.9 ± 1.6 %GC, P = 0.021) and more time in double-limb support (17.5 ± 1.6 vs. 15.4 ± 1.4 %GC, P = 0.026) than NW. In OWOB, at PSF, Cw was correlated to impulse (r = −0.57, P = 0.027) and stride frequency (r = 0.51, P = 0.046). Conclusions: Excess body weight is associated with greater Cw in older adults, possibly contributing to reduced mobility in overweight and obese older persons

Effects of obesity on walking patterns and adaptability during obstacle crossing

Obesity is a worldwide public health epidemic with no sign of yet abating. Although previous studies have examined the impact of obesity on walking, little is known about the effects of practice on walking patterns in individuals with obesity. The purpose of this current study was to evaluate whether an obstacle-crossing task may detect walking deficits in a group of adults electing to undergo bariatric surgery. With a cross-sectional design, we collected walking parameters as 24 adults (M age= 46.19, SD= 12.90) with obese body mass index (BMI) scores (M BMI= 41.68, SD= 5.80) and 26 adults (M age= 21.88, SD= 3.48) with normal BMI scores (M BMI= 23.09, SD= 4.47) walked in 5 conditions for 5 trials each: on flat ground, crossing over low, medium, and high obstacles, and again on flat ground. The timing and distance of participants' steps were collected with a mechanized gait carpet (GAITRite, Inc.). We conducted 5 (condition) repeated measures (RM) ANOVAs on our main dependent variables, which measured how fast (velocity) and long (step length) participants' steps were and how much time they spent with one (single limb support time) versus two (double limb support time) feet on the ground. The results showed within session improvements in participants' walking patterns. Comparisons of the first and last trials on flat ground showed that participants took longer, faster steps by increasing step length and velocity (ps<.01). They also spent more time with one versus two feet on the ground via increased single limb support time and decreased double limb support time (ps<.001). Our findings suggest that an obstacle-crossing task may help spur improvements in walking patterns even before adults elect to undergo bariatric surgery

Differences in Running Mechanics Between Overweight/Obese and Healthy Weight Children

Background/Purpose: Physical activity is commonly prescribed to reduce childhood obesity. However, due to differences in mechanics during low-impact activities, such as walking, obese children may be more prone to negative physical complications during high-impact activities, such as running. Therefore, this study analyzed the mechanical differences in running mechanics between healthy weight (HW) and overweight/obese (OV/OB) children. We hypothesized that when compared to HW children, OV/OB children would display higher vertical loading, greater joint moments and greater joint angular impulses during running. We also expect decreased sagittal plane range of motion and increased frontal plane range of motion of the hip, knee, and ankle joints in the OV/OB group during running. Methods: Ground reaction force (GRF) and joint kinematic data were collected for 42 children (25 HW, 17 OV/OB) while they ran across an implanted GRF platform at a given speed of 3.5 ± 5% m/s. Spatial-temporal and joint kinetic data (ankle, knee, & hip) were also determined. A one-way ANOVA was used to compare group differences for all variables of interest (

Comparative study: Parameters of gait in Down syndrome versus matched obese and healthy children

Being severely overweight is a distinctive clinical feature of Down syndrome (DS). Down syndrome is a complex multisystem disorder, representing the most common form of genetic obesity. The purpose of this study was to compare the spatiotemporal parameters of gait in genetically obese DS children and non-genetically obese children and compare their results with those obtained in a group of normal-weight control subjects. Fifteen patients with DS, 15 obese matched children and 15 healthy subjects from both sexes represented the sample of this study. Their age ranged from 12 to 14 years. Spatiotemporal gait parameters (total distance, step length, average step cycle, and walking speed) were assessed by using a Biodex Gait Trainer 2TM. Obese DS patients walked slower for a short distance, had a shorter step length and a lower cadence compared with both matched non-genetically obese and healthy subjects. Also, non-genetically obese matched children showed spatio-temporal gait parameters significantly different from healthy subjects. Subjects with DS had a gait pattern significantly different from obese children despite that both groups had a similar body mass index (BMI). Gait abnormalities in children with DS may be related to abnormalities in the development of motor skills in childhood, due to precocious obesity. A tailored rehabilitation program in the early childhood of DS patients could prevent gait pattern changes

Short-term effects of carrying a school bag on the distribution of force and plantar pressure during walking of children of different levels of physical activity

Introduction: Carrying a school bag is a dominant activity that a child performs during daily productive activities. The aim of the research is to examine how carrying a school bag of different weights affects the distribution of force and plantar pressure during normal walking on the flat terrain of children of varying levels of physical activity.Methods: The pilot study included 124 students aged 11-12 from Banja Luka. According to the protocol, each group of respondents was treated with an intervention-customized school bag and a comparator-school bag that the child only opted for. For the research, the Physical Activity Questionnaire for Older Children, measurement of anthropometric parameters, school bag weight, and Zebris tape (Zebris Medical GmbH, Germany) were used for gait analysis.Results: Inactive children achieved the lowest and active children’s highest walking speed during normal walking without a bag, with their customized school bag. When carrying a custom school bag: The highest maximum force is projected on the left heel 330.72 N in inactive children, and the lowest 265.93 N in moderately active children, the highest maximum pressure on the left heel is registered in inactive children, 27.60 N/cm2, and the lowest 21.85 N/cm2 in moderately active children. The maximum force-time of % of standing time on the left foot in the middle part lasted the longest in inactive children, and the shortest active children carried their school bag 40.31% and a custom school bag 39.76%.Conclusion: High physical activity and individual adjustment to distribute the burden well allow the child to adequately respond to the loads carried by the weight of the school bag

Biomechanical Risk Factors for Knee Osteoarthritis in Young Adults: The Influence of Obesity and Gait Instruction

With increasing rates of obesity, research has begun to focus of co-morbidities of obesity such as osteoarthritis. The majority of existing research has focused on older adults as the group most likely to suffer from osteoarthritis. The purpose of this study was to determine if overweight and obese young adults exhibit biomechanical risk factors for knee osteoarthritis, and to determine if young adults with biomechanical risk factors of osteoarthritis can modify these with instruction. This purpose was divided into two separate studies. Study 1: Thirty adults between 18-35 years old were recruited into three groups according to body mass index: normal, overweight, and obese. Participants walked through the lab while we collected 3-d kinematic and kinetic data. Overweight and obese young adults walked with similar gait compared to normal weight young adults. Study 2: Nine young adults between 18-35 years were recruited who walked with stiff-knee gait. Baseline measures of gait were collected in the form of 3-d kinematics and kinetics as participants walked through the laboratory. They then completed the gait instruction program which consisted of four blocks of training. Each block included ten single steps where the participant was provided feedback, followed by 100 practice steps around the laboratory. Participants were successful in increasing sagittal plane kinematics and kinetics of interest in the study. Conclusion: Identifying individuals who had biomechanical risk factors of osteoarthritis according to body mass index was not possible. According to the results of our study, obese and overweight young adults are not at increased risk of osteoarthritis compared to normal weight young adults. Individuals who may be at increased risk due to stiff-knee gait were able to improve their gait following instruction

Body mass index and its effect on plantar pressure in overweight and obese adults

The proportion of overweight or obese adults is creating a growing problem throughout the world. Overweight and obesity have a significant influence on gait, and often cause difficulty. There is evidence to suggest that being overweight or obese places adults at a greater risk of developing foot complications such as osteoarthritis, tendonitis, plantar fasciitis, and foot ulcers. Increasingly, pressure ulcers have become a serious health problem. The purpose of this research is to investigate the effect of body weight on the feet, and to investigate the use of simulated body mass to study the effect of variable body mass on the foot plantar in adults aged 24 to 50 years of age while walking at a self-selected pace. A series of studies were undertaken to achieve the above purpose. The research involved: 1) assessing dynamic foot plantar pressure characteristics in adults who are normal weight, overweight or obese; 2) studying the gait impact of increased simulated body weight (SBW); and 3) evaluating the spatial relationship between the trace of the centroid of the area of contact with heel strike, midstance, and toe-off phases for the SBW groups. F-Scan in-shoe systems were utilised to gather the foot pressure data. The first study sought to investigate the effect of different body mass index (BMI) levels on plantar pressure distribution during walking, collection in fifteen voluntary participants were recruited. The BMI participants were divided into three groups (healthy, overweight and obese). The foot was divided into ten regions: heel (H), midfoot (MF), first metatarsal head (1MH), second metatarsal head (2MH), third metatarsal head (3MH), fourth metatarsal head (4MH), fifth metatarsal head (5MH), hallux (1stT), second toe (2ndT), and third to fifth toes (3rd-5thT). For each region, the following parameters were calculated: force (F), contact area (CA), contact pressure (CP), pressure time integral (PTI) and peak pressure (PP). The mean of the three repetitions of each subject was computed, and statistical procedures were performed with these mean ± standard deviation (SD) values. This study showed that the obese group had higher plantar pressure parameter values compared to the other two groups (overweight and healthy) for the ten different foot regions. The study observed significant changes in the parameters in the H and MHs (e.g. 2MH and 3MH) foot regions. The forefoot appears to be more sensitive to weight-related pressure under the foot than the rearfoot. Findings from this study indicate that being overweight or obese increases foot pressure measures, even for individuals with similar body features. Higher BMI values correlate with a higher load on the foot during walking in males. These findings have implications for pain and discomfort in the lower extremity in the obese while participating in activities of daily living such as walking. The second study investigated the effect of the research methodology involving the simulation of body weight (SBW) with additional weight, adding 10, 20, 30 kg to each participant’s body weight on plantar pressures. The sample comprised 31 adult males; each subject walked four times. The first walk was without any external weight (NBW, 0 kg), the second walk was with a weight of 10 kg, the third walk was with a weight of 20 kg and the last walk with a weight of 30 kg in the vest. The foot was divided into ten regions and for each region, the parameters were calculated the same way as the first study. At the end of this study it should be noted that SBW groups subjected to load have shown changes in foot plantar measure values compared to the NBW group. Most of the differences were found under H, MHs, 1stT and MF regions in the most clinically relevant parameters in SBW groups compared to the control group; the SBW groups showed higher values of plantar pressure. The results of the ICC showed a generally good to an excellent level of reliability, the quality of which was dependent on the regions of the foot and the variables investigated with SBW loads. This experiment pointed out that an insole pressure system is a reliable tool for evaluating foot plantar forces and pressures throughout the walk. The plantar pressure measures can be used in relative assessments, as the measures of repeatability are favourable for the measures and foot zones generally utilised in the study of people with clinical problems like neuropathic diabetics. In the final study, associations were investigated of the centroid (coordinates x-axis and y-axis) of the area of contact captured between normal (NBW) and simulated body weight (SBW) changes. The same 31 adult males who enrolled with the SBW tests were used to collect the centroid of the area of contact with the surface. This was located by calculating the geometric centre of a set of cloud points having the lowest z coordinate value. In this part, a foot pressure sensing insole was used to calculate the moment of heel strike, midstance and toe-off phases. Data were analysed descriptively (mean ± SD only). The outcome of this study, relating to specific individual characteristics of the centroid trace of the plantar contact area was compared with the heel strike, midstance, and toe-off phases for the SBW group with the NSBW group. X-axis and y-axis coordinates in the heel strike, midstance and toe-off phases under SBW with 30, 20, 10 kg had higher mean values compared to NSW. The x-axis and y-axis coordinates had mean values of 11.76, 9.68, and 7.76 mm; while the y-axis coordinates had mean values of 11.96, 9.89, and 8.18 mm. Moreover, x-axis and y-axis coordinates were assessed in the midstance phase under SBW with 30, 20, 10 kg with means of 6.59, 5.48, and 4.50 mm; while the y-axis coordinates had mean values of 6.38, 5.41, and 4.41 mm. In addition, x-axis and y-axis coordinates were assessed in the toe-off phase under SBW (30, 20, 10 kg) with mean values of 11.56, 9.67, and 7.97 mm; while the y-axis coordinates had mean values of 11.51, 9.39, 8.02 mm, respectively. X-axis and y-axis coordinates had mean values in relation to NBW in three phases: heel strike of 5.47 and 6.15; midstance of 2.99 and 3.05; and toe-off of 6.04 and 5.82, respectively. The x-locate and y-locate change can be calculate the change in rotation of the ankle joint. As the data was normalised according to the total time taken for the loading phase of the gait, the y-locational change was due partly to the extra weight, which could increase the time of lifting the foot. Therefore, the results showed that the x-locate and y-locate change can help to calculate the change in the rotation of the ankle joint. The project has shown that it is possible to demonstrate that obese people will, throughout their lives, adopt ways to effectively execute a particular activity. This finding provides a foundation for future clinical trials which could assist in preventing foot complications and could assist in the design of appropriate interventions to promote healthy outcomes for these adults. The simulated body weight resulted in a variation in plantar pressure distribution. Because the human foot adapts itself to any simulated condition, knowledge of the variation of pressure distributions of both feet can provide input for suitable guidelines for biomedical engineers. To promote the prevention of likely injury to the feet of overweight and obese people, the results of this study demonstrate the need to develop strategies which could include the building of an insole (orthosis) that absorbs foot plantar pressure

Differences in Running Mechanics and Tibial Plateau Dimensions between Overweight/Obese and Healthy Weight Children

INTRODUCTION: Overweight and obese (OW/OB) children display increased knee joint loading during running, which may lead to excessive frontal plane motion and moments at the knee joints. The relationship between tibial plateau dimensions and knee vertical loading may explain the loading related injuries OW/OB children experience. PURPOSE: Compare knee mechanics during running and tibial plateau dimensions between healthy weight (HW) and OW/OB children. METHODS: Ten HW children and ten OW/OB children aged 9-12 participated in the study. Kinematic and kinetic data were captured as participants ran across a force platform at 3.5m/s. Tibial plateau area and density were collected by peripheral quantitative computed tomography. Frontal and sagittal plane knee angles and moments, vertical ground reaction forces (GRF) and temporal data were calculated. Mass, vertical GRF and joint moments were scaled by tibial plateau dimensions. A series of one-way ANOVAs were performed to compare group differences.RESULTS: OW/OB children displayed greater knee abduction during the stance phase of running. Mass, vertical GRF and knee joint moments scaled by tibial plateau dimensions were greater in the OW/OB group.DISCUSSION/CONCLUSION: OW/OB children display different running mechanics and loading patterns compared to HW children. The variables scaled by tibial plateau dimensions indicate that OW/OB children experience excessive loading at the knee during the stance phase of running. The excessive loading may lead to injuries such at ACL tears or osteoarthritis