Postural instability of extremely obese individuals improves after a body weight reduction program entailing specific balance training

Balance training exercises and postural control in overweight and obese children: A systematic review

BACKGROUND

Childhood Obesity causes potential changes in sensory input and disrupts postural control and stability. Implementing balance exercises has been shown to improve postural impairment, enhance motor task development, and reduce the risk of injury in this population.

OBJECTIVE

The aim of this study is to discover balance exercises to enhance postural control in overweight and obese children.

DESIGN

Systematic literature review.

METHODS

A comprehensive search was conducted across five electronic databases to find randomized controlled/randomized controlled clinical/Quasi-experimental studies pertaining to balance control exercises and childhood obesity. Each reviewer used the PEDro scale to independently assess the data that was retrieved from studies that satisfied the inclusion criteria. A risk-of-bias assessment was also conducted.

RESULTS

After fulfilling the inclusion and exclusion criteria, 4 articles were assimilated in the systematic review. Two independent authors verified and screened data, third author double-checked and searched for additional articles. The PEDro scale rated the studies as moderate to good (scores >6), with minimal bias. Key biases stemmed from the lack of blinding and concealment.

CONCLUSION

There is strong evidence suggesting that balance exercise not only enhance stability but also address the difficulties associated with excess body weight. Thus, the integration of balance exercises in the regimen of overweight and obese children proves effective in advancing postural control.

The usefulness of Integrative Neuromuscular Training to counteract obesity: a narrative review

BACKGROUND AND OBJECTIVE

The association between physical activity and diet has a valuable impact in weight status management to counteract obesity. In this context, within different training strategies (i.e., endurance, resistance training, concurrent training, agility training) the Integrative Neuromuscular Training (INT) represents a structured training mode focused on global human movement pattern development with the aim to enhance motor control, mobility and stability. In this narrative review we aimed to discuss the feasibility of INT interventions on physical fitness and body composition outcomes in individuals with obesity.

SUBJECTS

Medline/PubMed, EMBASE, Web of Science, Google Scholar including were searched before 1st February 2023 without restrictions on publication year.

METHODS

Two researchers extracted data from published trials. Randomized controlled trials or clinical trials, Body Mass Index of children and adolescents at the 95% percentile or greater, and for adults to be above 30 kg/m2, detailed intervention description, randomization process and allocation into an experimental or a control group, trials must have been written in English, were included.

RESULTS

We included a total of 19 studies complying with the inclusion criteria for the review process. There is evidence that INT promotes positive adaptations in fitness levels in both younger and older participants with concomitant ameliorations during a shorter, medium and longer time period. Moreover, cardiorespiratory fitness, muscular strength, balance, postural control and body composition reached significant remarkable improvements following a specific intervention based on INT principles compared to other training mode. However, Body Mass Index, fat mass percentage and waist circumference showed similar changes overtime.

CONCLUSIONS

Taken together, these findings support the effectiveness of INT in ameliorating physical fitness (i.e., health-related and skill related components) without negative changes in body composition. Nevertheless, fitness coaches and therapists may consider this training modality a feasible option when prescribing physical exercise in outpatients with obesity.

Obesity in rheumatological practice

Obesity is a chronic disease that leads to the development of secondary metabolic disturbances and diseases and strongly contributes to increased morbidity and mortality. On the other hand, musculoskeletal disorders are currently the main cause of disability and the second most frequent reason for visits to the doctor. Many studies clearly show that excessive body weight adversely affects the course of almost all musculoskeletal system diseases, from osteoarthritis, through metabolic, systemic connective tissue, to rarely diagnosed diseases. The impact of increased fat mass on the musculoskeletal system is presumably complex in nature and involves the influence of biomechanical, dietary, genetic, inflammatory and metabolic factors. Due to the epidemic nature of obesity and its serious health consequences, this disease requires energetic treatment. It is always based on lifestyle modification enriched, if necessary, by pharmacological and, in justified cases, surgical treatment.

Effects of Physical Activity Program on Body Composition, Physical Performance, and Neuromuscular Strategies during Walking in Older Adults with Sarcopenic Obesity: Randomized Controlled Trial

The potential impact of a specific physical activity program on biomechanical gait parameters and neuromuscular strategies around the ankle joint in older adults with sarcopenic obesity (SO) remains largely unexplored. The objective of this study was to investigate the effectiveness of a 24-week posture, strengthening, and motricity (PSM) program on improving neuromuscular strategies and biomechanical gait parameters in older adults with SO. 40 participants were randomly assigned to either the trained group (TG) and the control group (CG). Only the TG received the PSM program. Standardized evaluations were performed before and after the intervention, including walking tests on an instrumented gait analysis treadmill to evaluate biomechanical gait parameters and EMG activity of ankle muscles. After the PSM program, TG exhibited an increase in comfortable walking speed (+80%, p < 0.001) and step length (+38%, p < 0.05). Moreover, TG demonstrated a reduction in CoP velocity (-26%, p < 0.01). These gait modifications were associated with decreased muscle activity during the different gait phases (p < 0.05). The PSM program effectively improved gait and neuromuscular capacities in older adults with SO. Notably, these results shed light on the remarkable trainability of neuromuscular capacities in older adults with SO, despite the adverse effects of aging and obesity.

The Influence of Weight Loss in Postural Control in Women Undergoing Sleeve Gastrectomy

BACKGROUND

Bariatric surgery is the most effective procedure for obesity management, with a greater body weight loss and the remission of several diseases. The aim of this study was to analyze the relationships between the anthropometric profile and postural control outcomes in a group of obese adult women, and the effect of bariatric surgery on postural control.

METHODS

eighty-eight women candidates for bariatric surgery were recruited. Static balance was measured with the ARGO stabilometric platform under two conditions: open eyes (OE) and closed eyes (CE).

RESULTS

Multiple linear regression indicated BMI as the first predictor for postural control in all parameters, except for APO in open eyes, predicted mainly by height. Changes in body weight and BMI showed no statistically significant correlations with modification of postural control parameters (OE), while they appeared to exert an influence under closed eyes conditions.

CONCLUSIONS

Before surgery, obese patients with a higher BMI showed a better postural control. After surgery, the sway path and antero-posterior oscillation improved under open eyes conditions, while the magnitude of weight loss was negatively correlated with differences in postural control.

Does weight loss affect the center of pressure of children with obesity: a follow-up study

Background

Children with obesity were found to show the greater postural instability compared to the normal-weighted children. However, it’s still unclear if their altered postural control ability would recover towards normal pattern after weight loss. The purpose of this study was to investigate the effect of weight loss on the center of pressure (COP) for obese children.

Method

Totally 147 children were conducted a follow-up study in three years. A total number of 22 participants aged 7–13 years were recruited for their remission of obesity problem after 36 months. Their dynamic plantar pressure data were collected by Footscan pressure plate. The normalized time of four sub-phases, displacements and velocities of COP in anterior–posterior (AP) and medial–lateral (ML) directions were calculated to perform the Kolmogorov–Smirnov test and paired sample t test for statistical analyses.

Results

After weight loss, children’s normalized time of forefoot contact phase (FFCP) increased significantly, and their duration of flat foot phase (FFP) decreased significantly. They also exhibited the more medial and posterior orientated COP path after weight loss. In ML-direction, the COP displacement during FFP and FFPOP increased, and the COP velocity during FFPOP increased. In AP-direction, COP velocity during FFP and FFPOP increased.

Conclusions

The findings indicated that weight loss would have effects on the COP characteristics and postural stability for obese children. COP trajectory can provide essential information for evaluating foot function. The findings may be useful for obese children, medical staff, and healthcare physician.

Graphical Abstract

Effects of a Multicomponent Exercise Training Program on Balance Following Bariatric Surgery

Patients who undergo bariatric surgery (BS) have an increased risk of falls. Our aim was to determine if a multicomponent exercise intervention after BS improves balance. Eighty-four patients with obesity enrolled for BS were recruited and 1 month after BS randomly allocated to a control (CG; standard medical care) or exercise group (EG; exercise plus standard medical care) consisting of a supervised multicomponent training program (3d/week; 75 min/session; 5 months). Anthropometry, lower limb muscle strength (isokinetic dynamometer), vitamin D (ELISA) and balance in bipedal stance (force platform) were assessed pre-BS, 1 month and 6 months post-BS. One month post-BS, significant balance improvements were observed, namely in antero-posterior center of gravity (CoG) displacement and velocity, and medio-lateral and total CoG velocity. Between 1- and 6-months post-BS, improvements in balance were observed only in the EG, with a significant treatment effect on CoG displacement area and antero-posterior CoG displacement. No significant differences were observed between EG and CG over time in any of the anthropometric, muscle strength, and vitamin D variables assayed. In conclusion, a multicomponent exercise intervention program improves some balance parameters in patients with severe obesity following BS and therefore should be part of post-BS follow-up care as a potential strategy to reduce falls and associated injuries.

Bariatric surgery and exercise: A pilot study on postural stability in obese individuals

This study aimed to analyze the changes in postural stability of individuals with obesity after bariatric surgery, and the effect of three months of regular exercise on the static postural stability. Twenty-two subjects (7 females and 15 males) aged 31 to 68 years (Body mass index 35-55 kg.m-2) completed the study. Participants were divided into two groups: one group participated in an exercise program after the bariatric surgery (n = 10; age 48.9 ± 7.5 years; Body mass index 42 ± 5.6 kg.m-2) while the second group did not exercise at all after bariatric surgery (n = 12; age 44.7 ± 13.6 years, Body mass index 42.6 ± 6.0 kg.m-2). Static postural stability was measured using a Tekscan MobileMat pressure plate before and 4 months after the bariatric surgery. The exercise program included exercising three times a week including: one hour of strengthening, one hour of aerobic group exercise and at least one session of individual exercise at home. There were no significant differences in Center of force sway, Center of force ranges and average speed before and 4 months after bariatric surgery. Also, no effect of exercise was found. Post-pre differences of some parameters were negatively related to age (r from-0.46 to-0.72). Further studies are needed to explore this topic in depth.

Relation of Physical Activity Level to Postural Balance in Obese and Overweight Spanish Adult Males: A Cross-Sectional Study

The aim of this study was to analyze the influence of physical activity level on postural control in obese and overweight Spanish adult males. Forty-three males aged between 25 and 60 years old were included. Anthropometric, body composition, and physical activity variables were assessed, and postural control was evaluated using the Sensory Organization Test. No correlation was found between the level of physical activity and postural control, assessed by the Sensory Organization Test within the whole sample. However, within the group with a higher total fat mass percentage, non-sedentary individuals presented improved scores on the somatosensory organization test when compared to sedentary individuals (96.9 ± 1.8 vs. 95.4 ± 1.2; p < 0.05) and poorer scores on the composite equilibrium score (73.4 ± 7.2 vs. 79.2 ± 6.9; p < 0.05). The altered integration of somatosensory inputs most likely affects the tuning, sequencing, and execution of balance strategies in sedentary men with a high total fat mass percentage.

Multisensory postural control in adults: Variation in visual, haptic, and proprioceptive inputs

Maintaining balance is fundamentally a multisensory process, with visual, haptic, and proprioceptive information all playing an important role in postural control. The current project examined the interaction between such sensory inputs, manipulating visual (presence versus absence), haptic (presence versus absence of contact with a stable or unstable finger support surface), and proprioceptive (varying stance widths, including shoulder width stance, Chaplin [heels together, feet splayed at approximately 60°] stance, feet together stance, and tandem stance) information. Analyses of mean velocity of the Centre of Pressure (CoP) revealed significant interactions between these factors, with stability gains observed as a function of increasing sensory information (e.g., visual, haptic, visual + haptic), although the nature of these gains was modulated by the proprioceptive information and the reliability of the haptic support surface (i.e., unstable versus stable finger supports). Subsequent analyses on individual difference parameters (e.g., height, leg length, weight, and areas of base of support) revealed that these variables were significantly related to postural measures across experimental conditions. These findings are discussed relative to their implications for multisensory postural control, and with respect to inverted pendulum models of balance. (185 words).

The combined effects of obesity and ageing on skeletal muscle function and tendon properties in vivo in men

PURPOSE

We investigated the combined impact of ageing and obesity on Achilles tendon (AT) properties in vivo in men, utilizing three classification methods of obesity.

METHOD

Forty healthy, untrained men were categorised by age (young (18-49 years); older (50-80 years)), body mass index (BMI; normal weight (≥18.5-<25); overweight (≥25-<30); obese (≥30)), body fat% (normal adipose (<28%); high adiposity (≥28%)) and fat mass index (FMI; normal (3-6); excess fat (>6-9); high fat (>9). Assessment of body composition used dual-energy X-ray absorptiometry, gastrocnemius medialis (GM)/AT properties used dynamometry and ultrasonography and endocrine profiling used multiplex luminometry.

RESULTS

Older men had lower total range of motion (ROM; -11%; P = 0.020), GM AT force (-29%; P < 0.001), stiffness (-18%; P = 0.041), Young's modulus (-22%; P = 0.011) and AT stress (-28%; P < 0.001). All three methods of classifying obesity revealed obesity to be associated with lower total ROM (P = 0.014-0.039). AT cross sectional area (CSA) was larger with higher BMI (P = 0.030). However, after controlling for age, higher BMI only tended to be associated with greater tendon stiffness (P = 0.074). Interestingly, both AT CSA and stiffness were positively correlated with body mass (r = 0.644 and r = 0.520) and BMI (r = 0.541 and r = 0.493) in the young but not older adults. Finally, negative relationships were observed between AT CSA and pro-inflammatory cytokines TNF-α, IL-6 and IL-1β.

CONCLUSIONS

This is the first study to provide evidence of positive adaptations in tendon stiffness and size in vivo resulting from increased mass and BMI in young but not older men, irrespective of obesity classification.

Higher Body Mass Index Adversely Affects Knee Function After Anterior Cruciate Ligament Reconstruction in Individuals Who Are Recreationally Active

OBJECTIVE

Our aim was to investigate the effect of body mass index (BMI) levels on quadriceps and hamstring strength and functional outcomes up to 6 months after anterior cruciate ligament reconstruction (ACLR) with hamstring tendon autograft (HTG).

DESIGN

Prospective, controlled study.

SETTING

University clinical laboratory.

PATIENTS

Ninety-one participants who had undergone unilateral ACLR with HTG were divided into 2 groups according to their BMI. The participants whose BMI were between 18.5 and 24.9 kg/m were included in group 1 (n = 50, age: 27.2 ± 6.7 years, BMI: 22.3 ± 1.6 kg/m) and those whose BMI > 24.9 kg/m were included in group 2 (n = 41, age: 30.2 ± 6.9 years, BMI: 28.0 ± 2.4 kg/m).

INTERVENTIONS

Quadriceps and hamstring strength, functional performance including hop, jump, and balance performance, and IKDC score.

MAIN OUTCOME MEASURES

Maximum voluntary isometric contraction of the quadriceps and hamstring muscles and the body mass were measured at 1, 3, and 6 months after surgery. Absolute peak torques and normalized peak torques to body weight for both limbs were recorded. Functional outcomes were evaluated at 6 months after surgery.

RESULTS

Normalized quadriceps strength improvement was lower in group 2 when compared with group 1 (F(2,178) = 6.23, P = 0.003). Group 2 also demonstrated lower scores in functional performance (P < 0.05). Normalized hamstring and absolute quadriceps and hamstring strength improvement was not affected by higher BMI level (P > 0.05).

CONCLUSIONS

Higher BMI levels adversely affect quadriceps strength capacity and performance in patients who have undergone ACLR with HTG. Clinicians should consider BMI levels of patients when assessing and targeting muscle recovery because it could negatively affect the success of the ACLR rehabilitation.

Relationship of Body Composition with the Strength and Functional Capacity of People over 70 Years

BACKGROUND

Aging is a multifactorial physiological phenomenon, in which a series of changes in the body composition occur, such as a decrease in muscle mass and bone mineral density and an increase in fat mass. This study aimed to determine the relationship of muscle mass, osteoporosis, and obesity with the strength and functional capacity of non-dependent people over 70 years of age.

METHODS

A cross-sectional study was designed, whose study population was all people aged over 70 years, living independently and attending academic and recreational programs. Muscle strength and functional capacity of the participants were assessed by isometric exercises of lower and upper limbs and by four tests taken from the Senior Fitness Test, respectively. Bone mineral density, total mass, fat mass, total lean mass, arms lean mass, legs lean mass, and appendicular lean mass (ALM) was calculated by dual energy X-ray absorptiometry. Differences in muscle strength and functional capacity, according to the sex, muscle mass, mineral bone density and fat mass, were measured by χ2 test, independent samples Student's t-test, analysis of covariance and a 2-factor analysis of covariance; Results: 143 subjects were included in the study group. Men and women with an adequate amount of ALM adjusted for body mass index (BMI) had a maximal dynamic biceps strength in a single repetition, a maximal isometric leg extension strength, a maximal dynamic leg extension strength in a single repetition, a maximum right hand grip strength and maximum hand grip strength (the highest). Significantly higher values were observed in the maximal isometric biceps' strength in men with osteoporosis. Obese men had less isometric strength in the biceps and took longer to perform the chair stand test; Conclusions: Men and women with an adequate amount of ALM adjusted for BMI obtained better results in tests of muscle strength and functional capacity. However, osteoporosis and obesity are not related to these parameters.

ANTHROPOMETRIC FACTORS AND BODY COMPOSITION AND THEIR RELATIONSHIP WITH DYNAMIC BALANCE TESTS

ABSTRACT Introduction: The limit of stability is characterized by the maximum angle of inclination that an individual can reach and greater variability in extreme conditions; it is a bold and/or dangerous motor control strategy. Objective: Assess whether anthropometric measurements and body composition interfere with limits of stability and weight-bearing at different speeds in adults. Methods: Eighty-seven subjects of both sexes aged between 20 and 40 years were analyzed using anthropometric assessment and body composition. A force platform, limits of stability (LoS) and rhythmic weight shift (RWS) tests were used for the balance assessments. Results: In the LoS test, being female was negatively correlated with foot size and reaction time, and positively correlated with maximum excursion. In the RWS test, the female group had a negative correlation with height and upper limb length (ULL), with mediolateral directional control. The male group had a negative correlation with ULL and laterolateral directional control. Conclusion: Body composition variables do not interfere in the LoS and RWS tests in subjects with normal body mass index (BMI) values, except for bone densitometry (BMD) in women. As regards anthropometric parameters, height, ULL and foot size in the female and male groups were as follows: ULL and foot size exert little influence on postural balance control. Level of evidence II, Diagnostic studies - Investigation of a diagnostic test.

The effect of foot type, body length and mass on postural stability

BACKGROUND

Poor postural stability is associated with chronic ankle instability. Previous research showed an effect of foot type on postural stability. However, the specific effect of supinated feet remains unclear.

RESEARCH QUESTION

Our study aimed to assess the effect of foot type on postural stability, while taking potential confounding effects of body mass and body height into account.

METHODS

Forty-three healthy participants between 18 and 40 years old performed barefooted single leg stance tests with eyes open (EO) and closed (EC) on solid ground, and on a balance board (BB). Foot type was determined from pressure recordings during gait, using the arch index. Ground reaction forces were measured using a force plate. Outcome measures were Center of Pressure Velocity (COPV) divided by body height, and the Horizontal Ground Reaction Force (HGRF) divided by body mass. Generalized Estimating Equations models assessed the differences between supinated, normal and pronated feet during EO, EC and on a BB.

RESULTS

During EO an interaction between supinated feet and body mass showed an increase of COPV with 0.03 × 10^-2 1/s per kilogram of mass relative to normal feet (p = .03). During EC this interaction was more pronounced with 0.22 × 10^-2 1/s increase per kilogram mass (p < .01). The HGRF did not differ between foot types in any of the conditions.

SIGNIFICANCE

Supinated feet have a larger increase in COPV compared to normal feet with increasing mass when standing on solid ground during EO and EC. This indicates that people with supinated feet and a higher mass are less stable during single leg stance.

LEVEL OF EVIDENCE

Level 3, associative study.

Balance Control in Obese Subjects during Quiet Stance: A State-of-the Art

Obese individuals are characterized by a reduced balance which has a significant effect on a variety of daily and occupational tasks. The presence of excessive adipose tissue and weight gain could increase the risk of falls; for this reason, obese individuals are at greater risk of falls than normal weight subjects in the presence of postural stress and disturbances. The quality of balance control could be measured with different methods and generally in clinics its integrity is generally assessed using platform stabilometry. The aim of this narrative review is to present an overview on the state of art on balance control in obese individuals during quiet stance. A summary of knowledge about static postural control in obese individuals and its limitations is important clinically, as it could give indications and suggestions to improve and personalize the development of specific clinical programs.

Influence of Obesity and Impact of a Physical Activity Program on Postural Control and Functional and Physical Capacities in Institutionalized Older Adults: A Pilot Study

Objective: To evaluate the role of obesity in the effects of physical activity (PA) on postural control and functional and physical capacities in the older adults and to assess the effectiveness of a PA program on these capacities. Methods: Six obese (age = 78.8 [3.7] y; body mass index > 30 kg/m2), 7 overweight (age = 80.9 [2.8] y; 25 < body mass index < 30 kg/m2), and 6 normal weight (age = 80.8 [5.7] y; body mass index < 25 kg/m2) older adults performed the time up and go test, the 6-minute walk test, and the Tinetti test. Static and dynamic (forward leaning) postural control tests were also assessed. All these tests were similarly assessed 4 months later, during which only the obese group and overweight group participated in a PA program. Results: Before PA, results of the time up and go test, 6-minute walk test, Tinetti test, quiet standing, and forward lean tests revealed that physical capacities and static and dynamic postural control were impaired in the obese group when compared to the normal weight group. After PA, results of quiet standing, physical and functional tests were improved for obese group. Conclusions: Obesity is an additional constraint to age-related postural control and functional and physical capacities deteriorations. Nevertheless, a PA program is effective in improving balance and functional capacities in obese older adults.

Effects of obesity on postural balance and occurrence of falls in asymptomatic adults

Abstract Introduction: Previous studies suggested that body weight is a strong predictor for postural balance. High body mass index (BMI) presented an association with increased postural sway. However, it seems controversial since studies reported no difference between obese and control group regarding the position of the center of pressure in static postural balance (PB). Also, there is a lack of investigations about the impact of obesity on PB, free of the confound effect of cardiometabolic risk. Objective: The aim of this study was to evaluate the effects of obesity in static PB and occurrence of falls in asymptomatic adults and older adults over 40 years old. Method: The PB of 624 subjects divided into quartiles for BMI, waist-to-hip ratio, waist-to-height and fat body mass as percentage (%FBM) was assessed with and without vision using a force platform. An MANOVA was used to determine if there were differences between quartiles and a logistic regression analysis adjusted for confounders variables were applied to determine the obesity role in the occurrence of falls. Results: We found weak to moderate bivariate correlations between obesity and static PB, which became non-significant after adjustment. We found significant differences between first and fourth quartiles, especially using %FBM. Obesity was not related to the occurrence of falls since the odds ratio values became non-significant for all the indices of obesity after adjustment. Conclusion: Obesity presents little influence on maintaining static PB and seems not to determine the occurrence of falls among subjects over 40 years old.

A comparison of diet versus diet + exercise programs for health improvement in middle-aged overweight women

BACKGROUND

Obesity is an independent risk factor for many diseases. Many studies have investigated the benefits of losing weight as well as the best methods for weight loss. This research evaluated the impact of various weight loss programs on health enhancement among overweight women aged 40-60 years.

METHODS

This was a retrospective observational study that analyzed data from 145 overweight women in weight loss programs. Each woman joined one of four programs: 8 weeks of exercise plus diet (exe + nutr), 8 weeks of diet only (nutrition), 8 weeks of exercise only, or a control group. Women completed a psychological questionnaire and also underwent anthropometric tests, blood pressure checks, a predicted maximal oxygen consumption (VO2 max) test on an ergometer bicycle, a one-leg balance test, straight leg test, and a sit and reach test, both before and after the program. Participants also provided a blood sample.

RESULTS

All of the measured variables improved in the exe + nutr and nutrition programs when compared with the control group; the exe + nutr group improved the most: body mass index, -1.3 kg/m2; body fat, -2.9%; lean body mass, +1.1; VO2 max, +4.8; body image, +1.02; and p < 0.01.

CONCLUSION

The hypothesis-generating findings showed that weight loss programs improved anthropometric, biochemical, physiological, physical, and psychological variables in women aged 40-60 years. The program that included diet restriction with exercise, guidance, and regular counseling showed the best results.

Postural Stability in Obese Preoperative Bariatric Patients Using Static and Dynamic Evaluation

INTRODUCTION

Globally, 300 million adults have clinical obesity. Heightened adiposity and inadequate musculature secondary to obesity alter bipedal stance and gait, diminish musculoskeletal tissue quality, and compromise neuromuscular feedback; these physiological changes alter stability and increase injury risk from falls. Studies in the field focus on obese patients across a broad range of body mass indices (BMI >30 kg/m2) but without isolating the most morbidly obese subset (BMI ≥40 kg/m2). We investigated the impact of obesity in perturbing postural stability in morbidly obese subjects elected for bariatric intervention, harboring a higher-spectrum BMI.

SUBJECTS AND METHODS

Traditional force plate measurements and stabilograms are gold standards employed when measuring center of pressure (COP) and postural sway. To quantify the extent of postural instability in subjects with obesity before bariatric surgery, we assessed 17 obese subjects with an average BMI of 40 kg/m2 in contrast to 13 nonobese subjects with an average BMI of 30 kg/m2. COP and postural sway were measured from static and dynamic tasks. Involuntary movements were measured when patients performed static stances, with eyes either opened or closed. Two additional voluntary movements were measured when subjects performed dynamic, upper torso tasks with eyes opened.

RESULTS

Mean body weight was 85% (p < 0.001) greater in obese than nonobese subjects. Following static balance assessments, we observed greater sway displacement in the anteroposterior (AP) direction in obese subjects with eyes open (87%, p < 0.002) and eyes closed (76%, p = 0.04) versus nonobese subjects. Obese subjects also exhibited a higher COP velocity in static tests when subjects' eyes were open (47%, p = 0.04). Dynamic tests demonstrated no differences between groups in sway displacement in either direction; however, COP velocity in the mediolateral (ML) direction was reduced (31%, p < 0.02) in obese subjects while voluntarily swaying in the AP direction, but increased in the same cohort when swaying in the ML direction (40%, p < 0.04).

DISCUSSION AND CONCLUSION

Importantly, these data highlight obesity's contribution towards increased postural instability. Obese subjects exhibited greater COP displacement at higher AP velocities versus nonobese subjects, suggesting that clinically obese individuals show greater instability than nonobese subjects. Identifying factors contributory to instability could encourage patient-specific physical therapies and presurgical measures to mitigate instability and monitor postsurgical balance improvements.

Postural Changes After Abdominoplasty in Morbid Obese Patients

BACKGROUND

In the multidisciplinary treatment of obesity, the role of a plastic surgeon is to remove the excess of skin after weight loss to obtain cosmetic, functional, and psychological benefits. Obesity modifies body geometry, increases the mass of different segments, and imposes functional limitations in life activities that may predispose the obese to injury. The authors evaluated the postural conditions of obese patients, before and 12 months after surgery.

METHODS

The study included 15 obese patients of both genders affected by class II obesity. Postural function was evaluated preoperatively and 12 months postoperatively. Patients underwent conventional abdominoplasty surgical procedure. In all patients, plantar pressure distribution and balance (stabilometric test) were evaluated before and 3 months after surgery.

RESULTS

The static pedobarographic revealed a significant reduction in forefoot peak pressure; total plantar force; rearfoot plantar force percentage; midfoot plantar force percentage; and forefoot, midfoot, and rearfoot plantar contact areas percentage 3 months after surgery; the dynamic's one showed a reduction in the first metatarsal peak pressure and plantar contact. The stabilometric values showed a reduction in the range of center of foot pressure (CP) displacement along y axis, the average displacement of the CP speed from the mean (RMS y velocity), and CP mean peak in the condition of vision.

CONCLUSIONS

Our study demonstrates the beneficial effect of dermolipectomies and the consequential weight loss on postural stability of obese men. Such findings may support the hypothesis that dermolipectomy may improve postural stability with and without vision. The data demonstrate that the benefits are related to the magnitude of the resected tissue.

Postural control in healthy adults: Determinants of trunk sway assessed with a chest-worn accelerometer in 12 quiet standing tasks

Many diseases and conditions decrease the ability to control balance. In clinical settings, there is therefore a major interest in the assessment of postural control. Trunk accelerometry is an easy, low-cost method used for balance testing and constitutes an alternative method to the posturography using force platforms. The objective was to assess the responsiveness of accelerometry in a battery of 12 quiet standing tasks. We evaluated the balance of 100 healthy adults with an accelerometer fixed onto the sternum. We used the average amplitude of acceleration as an indirect measure of postural sways. The tasks of increased difficulty were realized with or without vision. The battery of tasks was repeated four times on two different days to assess reliability. We analyzed the extent to which the task difficulty and the absence of vision affected the trunk sway. The influence of individual characteristics (age, height, mass, sex, and physical activity level) was also assessed. The reliability analysis revealed that four repetitions of the battery of tasks are needed to reach a high accuracy level (mean ICC = 0.85). The results showed that task difficulty had a very large effect on trunk sways and that the removal of vision further increased sways. Concerning the effects of individual characteristics, we observed that women tended to oscillate more than men did in tasks of low difficulty. Age and physical activity level also had significant effects, whereas height and mass did not. In conclusion, age, sex, and physical fitness are confounders that should be considered when assessing patients’ balance. A battery of simple postural tasks measured by upper-trunk accelerometry can be a useful method for simple balance evaluation in clinical settings.

Nutritional Status, Body Mass Index, and the Risk of Falls in Community-Dwelling Older Adults: A Systematic Review and Meta-Analysis

OBJECTIVES

To evaluate the association between nutritional status, defined on the basis of a multidimensional evaluation, and body mass index (BMI) with the risk of falls and recurrent falls in community-dwelling older people.

DESIGN

Systematic literature review and meta-analysis.

SETTING AND PARTICIPANTS

Community-dwelling older adults.

MEASURES

A systematic literature review was conducted on prospective studies identified through electronic and hand searches until October 2017. A random effects meta-analysis was used to evaluate the relative risk (RR) of experiencing falls and recurrent falls (≥2 falls within at least 6 months) on the basis of nutritional status, defined by multidimensional scores. A random effects dose-response meta-analysis was used to evaluate the association between BMI and the risk of falls and recurrent falls.

RESULTS

People who were malnourished or those at risk for malnutrition had a pooled 45% higher risk of experiencing at least 1 fall than were those well-nourished (9510 subjects). Increased falls risk was observed in subjects malnourished versus well-nourished [RR 1.64, 95% confidence interval (CI) 1.18-2.28; 3 studies, 8379 subjects], whereas no substantial results were observed for risk of recurrent falls. A U-shaped association was detected between BMI and the risk for falls (P < .001), with the nadir between 24.5 and 30 (144,934 subjects). Taking a BMI of 23.5 as reference, the pooled RR of falling ranged between 1.09 (95% CI 1.04-1.15) for a BMI of 17, to 1.07 (95% CI 0.92-1.24) for a BMI of 37.5. No associations were observed between BMI and recurrent falls (120,185 subjects).

CONCLUSIONS/IMPLICATIONS

The results of our work suggest therefore that nutritional status and BMI should be evaluated when assessing the risk for falls in older age.

Unilateral Stability and Visual Feedback Body Control Improves After Three-Month Resistance Training in Overweight Individuals

The authors evaluated the effect of 3 months of resistance and aerobic training (3 sessions/week) on body balance in a group of 25 overweight and obese individuals. Prior to and after the training, they performed static and task-oriented balance tests under various conditions. Mean center of pressure (CoP) velocity and mean trace length of the CoP in the y-axis registered during a one-legged stance significantly decreased after the resistance training (19.1%, p = .024; 29.3%, p = .009). Mean trace length of the CoP in the y-axis decreased significantly also during a bipedal stance on a foam surface with eyes open and closed (10.9%, p = .040; 18.2%, p = .027). In addition, mean CoP distance and mean squared CoP distance in the anteroposterior direction during a visually guided center of mass (CoM) tracking task significantly improved (14.7%, p = .033; 28.2%, p = .016). However, only mean trace length of the CoP in the y-axis during a bipedal stance on a foam surface with eyes open and closed significantly decreased after the aerobic training (10.3%, p = .047; 16.5%, p = .029). It may be concluded that resistance training is more efficient for the improvement of the anteroposterior unilateral stability and the accuracy of the regulation of the CoM anteroposterior position than aerobic training in overweight and obese individuals.

Obesity and Falls in a Prospective Study of Older Men: The Osteoporotic Fractures in Men Study

OBJECTIVE

The aim of this study is to evaluate fall rates across body mass index (BMI) categories by age group, considering physical performance and comorbidities.

METHOD

In the Osteoporotic Fractures in Men (MrOS) study, 5,834 men aged ≥65 reported falls every 4 months over 4.8 (±0.8) years. Adjusted associations between BMI and an incident fall were tested using mixed-effects models.

RESULTS

The fall rate (0.66/man-year overall, 95% confidence interval [CI] = [0.65, 0.67]) was lowest in the youngest, normal weight men (0.44/man-year, 95% CI = [0.41, 0.47]) and greatest in the oldest, highest BMI men (1.47 falls/man-year, 95% CI = [1.22, 1.76]). Obesity was associated with a 24% to 92% increased fall risk in men below 80 ( p_trend ≤ .0001, p for interaction by age = .03). Only adjustment for dynamic balance test altered the BMI-falls association substantially.

DISCUSSION

Obesity was independently associated with higher fall rates in men 65 to 80 years old. Narrow walk time, a measure of gait stability, may mediate the association.

The impact of obesity on skeletal muscle strength and structure through adolescence to old age

Obesity is associated with functional limitations in muscle performance and increased likelihood of developing a functional disability such as mobility, strength, postural and dynamic balance limitations. The consensus is that obese individuals, regardless of age, have a greater absolute maximum muscle strength compared to non-obese persons, suggesting that increased adiposity acts as a chronic overload stimulus on the antigravity muscles (e.g., quadriceps and calf), thus increasing muscle size and strength. However, when maximum muscular strength is normalised to body mass, obese individuals appear weaker. This relative weakness may be caused by reduced mobility, neural adaptations and changes in muscle morphology. Discrepancies in the literature remain for maximal strength normalised to muscle mass (muscle quality) and can potentially be explained through accounting for the measurement protocol contributing to muscle strength capacity that need to be explored in more depth such as antagonist muscle co-activation, muscle architecture, a criterion valid measurement of muscle size and an accurate measurement of physical activity levels. Current evidence demonstrating the effect of obesity on muscle quality is limited. These factors not being recorded in some of the existing literature suggest a potential underestimation of muscle force either in terms of absolute force production or relative to muscle mass; thus the true effect of obesity upon skeletal muscle size, structure and function, including any interactions with ageing effects, remains to be elucidated.

Ball games and nutrition counseling improve postural control in overweight children

Background

Motor skills are impaired in overweight children whose levels of physical activity are low and these children are more likely to sustain lower extremity injuries.

The purpose of this study was to analyze prospectively in overweight children the influence of ball games and nutrition counseling on postural control.

Methods

In all, 46 overweight children (age: 6–12 years, BMI: female: 25.2 ± 3.6 kg/m², male: 26.2 ± 2.8 kg/m² (mean value ± standard deviation) were examined prospectively in four randomized groups (ball games, nutrition counseling, ball games and nutrition counseling, and group without intervention) for six months. A one-legged standing test was performed.

Results

The children demonstrated improved postural control after six months of intervention: mean difference M1-M2 ± standard deviation: 5 ± 6 error points (p < 0.001, T = 4.906), whereas the control group without intervention did not show any significant improvement: 2 ± 8 error points (p = 0.357, T = 0.972).

Conclusions

Ball games and nutrition counseling have a positive influence on postural control and therefore could help prevent injury.

Trial registration

ClinicalTrials.gov Identifier: NCT01825174.

Registered April 2, 2013

Relation between the Sensory and Anthropometric Variables in the Quiet Standing Postural Control: Is the Inverted Pendulum Important for the Static Balance Control?

The aim of this study was to evaluate the relation between the sensory and anthropometric variables in the quiet standing. Methods. One hundred individuals (50 men, 50 women; 20–40 years old) participated in this study. For all participants, the body composition (fat tissue, lean mass, bone mineral content, and bone mineral density) and body mass, height, trunk-head length, lower limb length, and upper limb length were measured. The center of pressure was measured during the quiet standing posture, the eyes opened and closed with a force platform. Correlation and regression analysis were run to analyze the relation among body composition, anthropometric data, and postural sway. Results. The correlation analysis showed low relation between postural sway and anthropometric variables. The multiple linear regression analyses showed that the height explained 12% of the mediolateral displacement and 11% of the center of pressure area. The length of the trunk head explained 6% of displacement in the anteroposterior postural sway. During eyes closed condition, the support basis and height explained 18% of mediolateral postural sway. Conclusion. The postural control depends on body composition and dimension. This relation is mediated by the sensory information. The height was the anthropometric variable that most influenced the postural sway.

The relationship between excess body weight and the risk of death from unnatural causes

OBJECTIVE

The purpose is to exam whether excess body weight is associated with an increased risk of death from unnatural causes, particularly, injury.

METHOD

We analyzed nationally representative data of 14,453 adults (19 and older) who participated in the third National Health and Nutrition Examination Survey, 1988-1994, and were followed up with vital statuses through December 31, 2006. We used Cox proportional hazard regression to estimate the hazard ratio (HR) of death from all unnatural causes combined and specific ones. Gray's test was performed to assess the equality of cumulative incidence functions between body mass index (BMI) levels.

RESULTS

A total of 128 unnatural deaths were recorded during an 18-year follow-up with 193,019 person-years accumulated. Compared with healthy weight participants, a person with excess body weight had a low hazard of death from unnatural causes [HR=1.00 (reference), 0.58 (0.39-0.87), and 0.50 (0.30-0.82) for healthy weight, overweight and obese participants, respectively]. Injuries, including motor vehicle accidents and falls, were the major types of unnatural deaths (n=91, 71% of all unnatural deaths), and the risk of death from injuries was linearly and reversely associated with BMI. The HRs of injury were 1.00 (reference), 0.57 (0.36-0.91), and 0.36 (0.19-0.69) for healthy weight, overweight and obese participants, respectively. All these estimates were obtained after adjustment of socio-demographic variables.

DISCUSSION

Excess body weight appears to be associated with a low risk of death from unnatural causes, particularly, injuries. Additional investigations on the mechanism underlying the relationship between BMI and unnatural deaths are warranted.

Are overweight/obese children at risk of traumatic dental injuries? A meta-analysis of observational studies

BACKGROUND/AIM

Observational studies which investigated the association between overweight/obesity and traumatic dental injuries (TDI) reported contrasting results. Thus, this meta-analysis was designed to investigate such an association with the highest possible levels of internal and external validities.

MATERIAL AND METHODS

A comprehensive literature search was performed through PubMed, ISI Web of Science, Cochrane Library, Scopus, Google scholar to ensure generalizability. Eligible studies reported clear case and control definitions, exposure assessment. Where possible, odds ratio (OR) adjusted for covariates was extracted. Study quality was assessed through Newcastle-Ottawa Scale (NOS). Only fair-to-good quality studies with NOS scores ≥4 were selected. The method to assess the pooled OR was based on the level of between-study heterogeneity, estimated through the Cochran's Q. Reliability of the pooled OR was improved by controlling for publication bias, sensitivity analysis to study inclusion, and subgroup analyses according to tooth type (permanent vs primary teeth) and country where the study was performed (Brazilian studies vs studies from other countries).

RESULTS

Seventeen studies were selected from America, Asia, and Europe, their NOS scores ranged between 4 and 8. Overall, there were almost 28,000 patients, 7400 of them with TDI. The level of publication bias was minimal, and no adjustment was necessary. Between-study heterogeneity was high, and the random-effects method was used to assess the pooled OR, which resulted 1.30 (95% confidence interval, 1.11-1.53; P < 0.05). Sensitivity and subgroup analyses corroborated this estimate.

CONCLUSION

The choice to increase internal and external validity levels decreased the precision of the pooled OR (i.e., confidence intervals were relatively wide). The statistically significant overweight/obesity-TDI association, together with the so-called counterfactual condition (i.e., TDI prevalence was higher among overweight/obese children than among lean children), suggests that causal association between these two conditions is plausible.

Combined effects of body composition and ageing on joint torque, muscle activation and co-contraction in sedentary women

This study aimed to establish the interplay between body mass, adiposity, ageing and determinants of skeletal muscle strength. One hundred and two untrained healthy women categorised by age into young (Y) (mean ± SD, 26.7 ± 9.4 years) vs. old (O) (65.1 ± 7.2 years) were assessed for body fat, lean mass, plantar flexion and dorsiflexion maximum voluntary isometric contraction (MVC) torque, muscle activation capacity and antagonist muscle co-contraction. MVC torque normalised to body mass in the obese group was 35 and 29 % lower (p < 0.05) in Y and 34 and 31 % lower (p < 0.05) in O, compared with underweight and normal weight individuals, respectively. Y with ≥40 % body fat had significantly lower activation than Y with <40 % body fat (88.3 vs. 94.4 %, p < 0.05), but O did not exhibit this effect. Co-contraction was affected by ageing (16.1 % in O vs. 13.8 % in Y, p < 0.05) but not body composition. There were significant associations between markers of body composition, age, strength and activation capacity, with the strongest correlation between muscle strength and total body mass (r (2) = 0.508 in Y, p < 0.001, vs. r (2) = 0.204 in O, p < 0.01). Furthermore, the age-related loss in plantar flexion (PF) MVC torque was exacerbated in obese compared to underweight, normal weight and overweight individuals (-0.96 vs. -0.54, -0.57 and -0.57 % per year, p < 0.05). The negative impact of adiposity on muscle performance is associated with not only muscular but also neural factors. Overall, the effects of ageing and obesity on this system are somewhat cumulative.

Correlates of perceived health related quality of life in obese, overweight and normal weight older adults: an observational study

Background

Obesity is a complex multifactorial disease, which also has an impact on quality of life. The aim of this paper is to identify the correlates of perceived health related quality of life in obese, overweight and normal weight Italians older adults.

Methods

205 subjects at the age ≥ 60 yrs. were recruited into the Division of Endocrinology of the Polytechnic University of Marche Region, Ancona (Italy). A protocol of questionnaires was constructed for data collection, and included domains such as physical activity, quality of life, socio-psychological aspects. The association of the latter variables with SF-36 Health Survey physical component (PCS-36) were evaluated in the whole sample. Multiple linear regression models were used to assess the effect of independent variables on PCS-36 and the physical subscales of SF-36.

Results

PCS-36 showed a lower score in the obese and overweight subjects than the normal weight group (post-hoc test, p < 0.001 and p < 0.05 respectively). Age, gender (male), Body Mass Index, years of education, Physical Activity Scale for the Elderly (PASE) total score, Hospital Anxiety and Depression Scale anxiety, Hospital Anxiety and Depression Scale depression, number of medications prescribed and number of diseases were included in the model. Negative and significant PCS-associated variables included depression (p = 0.009), BMI (p = 0.001), age in years (p = 0.007), whereas positive and significant PCS-associated independent variables were years of education (p = 0.022), physical activity (p = 0.026). BMI was negatively associated with all the physical subscales of SF-36 (p < 0.05).

Conclusions

Research funding should be invested in the study of the benefits accruing from reducing obesity in the elderly.

Quantitative 3D evaluation of step ascent and descent in individuals with Down syndrome--analysis of a daily challenging task

BACKGROUND

Step ascent and descent can perturb stability increasing the incidence of falls, especially in older individuals with functional limitations and intellectual disabilities, such as those with Down syndrome (DS). The aim of this study was to investigate the biomechanics and motor coordination of step ascent and descent in adults with DS and compare them with a group of healthy individuals, considering movement kinematics and kinetics.

METHOD

Fourteen adults with DS and 12 similarly aged adults without DS who were free of known motor problems were quantitatively assessed during ascending and descending a step using an optoelectronic system (BTS SMART-D), force platforms and video recording. Kinematic and kinetic parameters were identified and calculated for each study participant and comparisons were made between the DS and a control group (CG).

RESULTS

Despite similar age ranges, subjects in the DS group performed the step ascent and descent movements slower, with longer duration and with a more accentuated range of motion of the trunk and of the ankle joint than those in the CG. Additionally, the double stance phase on the step was substantially longer in the DS group when represented as a percentage of the entire stepping sequence (ascent, double stance on the step and descent). In terms of kinetics, ground force platform data revealed that the DS subjects showed higher instability in the medio-lateral direction during double support phase than similarly aged CG subjects and cannot be attributed to age-associated changes in stability.

CONCLUSIONS

These findings help to elucidate the complex biomechanical strategy of people with DS during a step ascent and descent movement task and may have a major role in the multidimensional evaluation and tailored management for them.

The impact of obesity on balance control in community-dwelling older women

Older individuals have impaired balance control, particularly those that are frail and/or have sensory deprivations. Obese individuals show faster body sway during upright stance than normal weight individuals, suggesting that they also have difficulty controlling balance even if they do not have the same sensory issues as the older people. Therefore, the objective of this study was to examine if obesity is associated to a decreased balance control in older women. Postural sway of normal weight (n = 15, age = 70.8 ± 5.5 years; BMI = 22.2 ± 1.9 kg/m(2)), overweight (n = 15, age = 71.7 ± 4.3 years; BMI = 27.3 ± 1.3 kg/m(2)), and obese (n = 15, age = 71.1 ± 4.3 years; BMI = 33.1 ± 3.4 kg/m(2)) women was measured with a force platform for normal quiet stance lasting for 30 s in opened and closed eyes conditions. The obese group oscillated at a faster speed than the normal weight group (vision 0.99 ± 0.29 cm/s vs. 0.70 ± 0.16 cm/s, p < 0.01; no vision 1.43 ± 0.50 cm/s vs. 0.87 ± 0.23 cm/s, p < 0.01). The obese group exhibited greater range in both axes without vision compared to the normal weight group (p < 0.05). When observing sway density parameters, the obese group also spent less time in stability zones (2 mm radius area in which the center of pressure is relatively stable), and the distance between these stability zones are greater than the normal weight group in both visual conditions (p < 0.01 and p < 0.05, respectively). Obesity clearly affects postural control in older women. Our results suggest that obesity has a negative impact on the capacity of older woman to adequately use proprioceptive information for posture control. As postural instability or balance control deficits are identified as a risk factor for falling, our results also suggest that obesity in older women could be considered as another potential contributing factor for falling.

Does lower extremity osteoarthritis exacerbate risk factors for falls in older adults?

The risk of falling reportedly increases almost 2.5-times in those with lower extremity osteoarthritis (OA(LE)) compared with age-matched controls. However, the mechanisms underlying the increased risk are not clear. The risk factors for falls in people with OA(LE) found in the literature are mostly the same as the risk factors for people without OA(LE). It is hypothesized that risk factors for falls are exacerbated by OA(LE), such that these individuals are more likely to become dynamically unstable and, once this has occurred, are less able to perform an appropriate compensatory stepping response compared with people without OA(LE). To the extent that this is true, task-specific training targeting the compensatory step, which decreases falls in middle-aged and older women, should be effective for people with OA(LE). The purpose of the present review is to provide the rationale for the above hypothesis. Furthermore, the present authors present evidence that the fall risk of people with OA(LE) could be efficiently and effectively reduced using task-specific training previously shown to reduce falls in middle aged and older women.

The influence of anthropometric factors on postural balance: the relationship between body composition and posturographic measurements in young adults

OBJECTIVE

The aim of the present study was to evaluate the influence of anthropometric characteristics and gender on postural balance in adults. One hundred individuals were examined (50 males, 50 females; age range 20-40 years).

METHODS

The following body composition measurements were collected (using bone densitometry measurements): fat percentage (% fat), tissue (g), fat (g), lean mass (g), bone mineral content (g), and bone mineral density (g/cm²). In addition, the following anthropometric measurements were collected: body mass (kg), height (cm), length of the trunk-cephalic region (cm), length of the lower limbs (cm) and length of the upper limbs (cm). The following indices were calculated: body mass index (kg/m²), waist-hip ratio and the support base (cm²). Also, a postural balance test was performed using posturography variables with open and closed eyes.

RESULTS

The analysis revealed poor correlations between postural balance and the anthropometric variables. A multiple linear regression analysis demonstrated that the whole group (female and male) height explained 12% of the medial-lateral displacement, 10% of the speed of oscillation, and 11% of the displacement area. The length of the trunk-cephalic length explained 6% of the displacement in the anteroposterior direction. With eyes closed, the support base and height explained 18% of the medial displacement, and the lateral height explained 10% of the displacement speed and 5% of the scroll area.

CONCLUSION

Measured using posturography, the postural balance was only slightly influenced by the anthropometric variables, both with open and closed eyes. Height was the anthropometric variable that most influenced postural balance, both in the whole group and separately for each gender. Postural balance was more influenced by anthropometric factors in males than females.

Exercise intervention for management of obesity

Obesity touches the lives of most Americans regardless of age. In adults, accrual of co-morbidities, including frank disability, impacts health in ways that mandate aggressive public health action. In children, the rising prevalence of overweight and obesity raises serious prospective concerns for life as these children enter adulthood. Action is imperative to provide medical interventions and preventive strategies to reduce the threat this condition poses to future generations. Obesity primarily results from an energy regulation imbalance within the body; understanding its origin and effects requires considering both the intake (via eating) and output (via moving) of energy. This article focuses on how exercise and physical activity (i.e., energy output) can influence the primary condition of obesity and its health sequelae. Components, strategies, and expected outcomes of exercise and lifestyle activity are addressed. Successful long-term participation in daily movement requires matching exercise regimens and physical activity outlets to individual preferences and environmental conditions. Activity habits of Americans must change at home and in the workplace, schools and the community to positively influence health. Although the goals of Healthy People 2010 to reduce sedentary behavior have not been met, success of other public health interventions (e.g., immunizations, use of bicycle helmets) suggests that social change to alter activity habits can be achieved. Failure to reach our public health goals should serve as a catalyst for broad-based action to help children, adolescents, and adults attain and maintain behaviors that reduce the risk of obesity and its health insults.

Postural adaptations to long-term training in Prader-Willi patients

Background

Improving balance and reducing risk of falls is a relevant issue in Prader-Willi Syndrome (PWS). The present study aims to quantify the effect of a mixed training program on balance in patients with PWS.

Methods

Eleven adult PWS patients (mean age: 33.8 ± 4.3 years; mean BMI: 43.3 ± 5.9 Kg/m2) attended a 2-week training program including balance exercises during their hospital stay. At discharge, Group 1 (6 patients) continued the same exercises at home for 6 months, while Group 2 (5 patients) quitted the program. In both groups, a low-calorie, well-balanced diet of 1.200 kcal/day was advised. They were assessed at admission (PRE), after 2 weeks (POST1) and at 6-month (POST2). The assessment consisted of a clinical examination, video recording and 60-second postural evaluation on a force platform. Range of center of pressure (CoP) displacement in the antero-posterior direction (RANGE_AP index) and the medio-lateral direction (RANGE_ML index) and its total trajectory length were computed.

Results

At POST1, no significant changes in all of the postural parameters were observed. At completion of the home program (POST2), the postural assessment did not reveal significant modifications. No changes in BMI were observed in PWS at POST2.

Conclusions

Our results showed that a long-term mixed, but predominantly home-based training on PWS individuals was not effective in improving balance capacity. Possible causes of the lack of effectiveness of our intervention include lack of training specificity, an inadequate dose of exercise, an underestimation of the neural and sensory component in planning rehabilitation exercise and failed body weight reduction during the training. Also, the physiology of balance instability in these patients may possibly compose a complex puzzle not affected by our exercise training, mainly targeting muscle weakness.

Mechanisms underlying center of pressure displacements in obese subjects during quiet stance

Objective

the aim of this study was to assess whether reduced balance capacity in obese subjects is secondary to altered sensory information.

Design

cross sectional study.

Subjects

44 obese (BMI = 40.6 ± 4.6 kg/m² , age = 34.2 ± 10.8 years, body weight: 114,0 ± 16,0 Kg, body height 167,5 ± 9,8 cm) and 20 healthy controls (10 females, 10 males, BMI: 21.6 ± 2.2 kg/m², age: 30.5 ± 5.5 years, body weight: 62,9 ± 9,3 Kg, body height 170,1 ± 5,8 cm) were enrolled.

Measurements

center of pressure (CoP) displacements were evaluated during quiet stance on a force platform with eyes open (EO) and closed (EC). The Romberg quotient (EC/EO) was computed and compared between groups.

Results

we found statistically significant differences between obese and controls in CoP displacements (p < 0.01) and no statistically significant differences in Romberg quotients (p > 0.08).

Conclusion

the increased CoP displacements in obese subjects do not need an hypothesis about altered sensory information. The integration of different sensory inputs appears similar in controls and obese. In the latter, the increased mass, ankle torque and muscle activity may probably account for the higher CoP displacements.

Pharmacogenetics of osteoporosis-related bone fractures: moving towards the harmonization and validation of polymorphism diagnostic tools

Osteoporosis is one of the most common skeletal chronic conditions in developed countries, hip fracture being one of its major healthcare outcomes. There is considerable variation in the implementation of current pharmacological treatment and prevention, despite consistent recommendations and guidelines. Many studies have reported conflicting findings of genetic associations with bone density and turnover that might predict fracture risk. Moreover, it is not clear whether genetic differences exist in relation to the morbidity and efficiency of the pharmacotherapy treatments. Clinical response, including beneficial and adverse events associated with osteoporosis treatments, is highly variable among individuals. In this context, the present article intends to summarize putative candidate genes and genome-wide association studies that have been related with BMD and fracture risk, and to draw the attention to the need for pharmacogenetic methodology that could be applicable in clinical translational research after an adequate validation process. This article mainly compiles analysis of important polymorphisms in osteoporosis documented previously, and it describes the simple molecular biology tools for routine genotype acquisition. Validation of methods for the easy, fast and accessible identification of SNPs is necessary for evolving pharmacogenetic diagnostic tools in order to contribute to the discovery of clinically relevant genetic variation with an impact on osteoporosis and its personalized treatment.

Clinical and demographic characteristics associated with postural instability in patients with schizophrenia

As people with schizophrenia grow older, prevention of falls in this older population has become a public health priority. It is therefore critically important to identify risk factors to effectively prevent falls. For this purpose, the degree of postural sway can serve as a convenient index of risk assessment. The objective of this study was to find clinical and demographic characteristics associated with postural instability. Inpatients and outpatients with schizophrenia or related psychosis were recruited at 2 hospitals in Japan. The clinical stabilometric platform, which measured a range of the trunk motion, and extrapyramidal side effects were evaluated between 9 and 11 A.M. Four hundred two subjects were enrolled (age: mean, 55.5 [SD, 14.4] years). A univariate general linear model showed that the use of antipsychotic drugs with a chlorpromazine equivalent of 10 or greater, being overweight, and inpatient treatment setting were associated with a greater degree of the range of postural sway. Another general linear model, including a subgroup of 300 subjects who did not present any extrapyramidal side effects, not only consolidated these findings, but also revealed a great degree of postural sway in older subjects. In addition, quetiapine was found to be associated with a greater range of postural sway among atypical antipsychotics. Schizophrenia patients generally showed a greater degree of postural instability, compared with the reference data of healthy people. These findings highlight truncal instability as a risk factor of falls in patients with schizophrenia, especially when they are overweight, old, and/or receiving antipsychotics with a chlorpromazine equivalent of 10 or greater, including quetiapine.

Characterisation of balance capacity in Prader-Willi patients

Being severely overweight is a distinctive clinical feature of Prader-Willi Syndrome (PWS). This explorative study aims to characterise balance capacity in PWS as compared to non-genetically obese patients (O) and to a group of normal-weight individuals (CG). We enrolled 14 PWS patients: 8 females and 6 males (BMI = 41.3 ± 7.3 kg/m(2), age = 32.86+4.42 years), 44 obese individuals, 22 males and 22 females (BMI = 40.6 ± 4.6 kg/m(2), age = 34.2 ± 10.7 years) and 20 controls (CG: 10 females and 10 males; BMI: 21.6 ± 1.6 kg/m(2); age: 30.5 ± 5.3 years). Postural acquisitions were conducted by means of a force platform from which the COP pattern vs time was analysed. The participants were required to stand barefoot on the platform with eyes open and heels at standardized distance and position for 60s. All of the analysed parameters were statistically different from O and CG groups. PWS individuals showed greater displacements in both the A/P and M/L direction (RMS, RANGE and MV indices). Analysis of the overall planar movement of the CoP showed that the PWS patients were characterised by higher RMS distance from the centre (RMS(CoP) index) and area of confidence ellipse (AREA(CoP) index) when compared both to obese and healthy individuals. PWS patients showed a poorer balance capacity than their non-genetically obese counterparts and healthy individuals, with greater differences in both the A/P and M/L direction than O. Rehabilitation programs for PWS should take this finding into account. In addition to weight loss, strengthening of ankle flexors/extensors, and balance training, tailored interventions aimed at improving A/P control should be given particular consideration.

Obesity impact on the attentional cost for controlling posture

Background

This study investigated the effects of obesity on attentional resources allocated to postural control in seating and unipedal standing.

Methods

Ten non obese adults (BMI = 22.4±1.3, age = 42.4±15.1) and 10 obese adult patients (BMI = 35.2±2.8, age = 46.2±19.6) maintained postural stability on a force platform in two postural tasks (seated and unipedal). The two postural tasks were performed (1) alone and (2) in a dual-task paradigm in combination with an auditory reaction time task (RT). Performing the RT task together with the postural one was supposed to require some attentional resources that allowed estimating the attentional cost of postural control. 4 trials were performed in each condition for a total of 16 trials.

Findings

(1) Whereas seated non obese and obese patients exhibited similar centre of foot pressure oscillations (CoP), in the unipedal stance only obese patients strongly increased their CoP sway in comparison to controls. (2) Whatever the postural task, the additional RT task did not affect postural stability. (3) Seated, RT did not differ between the two groups. (4) RT strongly increased between the two postural conditions in the obese patients only, suggesting that body schema and the use of internal models was altered with obesity.

Interpretation

Obese patients needed more attentional resources to control postural stability during unipedal stance than non obese participants. This was not the case in a more simple posture such as seating. To reduce the risk of fall as indicated by the critical values of CoP displacement, obese patients must dedicate a strong large part of their attentional resources to postural control, to the detriment of non-postural events. Obese patients were not able to easily perform multitasking as healthy adults do, reflecting weakened psycho-motor abilities.

Genetic determinants of osteoporosis: common bases to cardiovascular diseases?

Osteoporosis is the most common and serious age-related skeletal disorder, characterized by a low bone mass and bone microarchitectural deterioration, with a consequent increase in bone fragility and susceptibility to spontaneous fractures, and it represents a major worldwide health care problem with important implications for health care costs, morbidity and mortality. Today is well accepted that osteoporosis is a multifactorial disorder caused by the interaction between environment and genes that singularly exert modest effects on bone mass and other aspects of bone strength and fracture risk. The individuation of genetic factors responsible for osteoporosis predisposition and development is fundamental for the disease prevention and for the setting of novel therapies, before fracture occurrence. In the last decades the interest of the Scientific Community has been concentrated in the understanding the genetic bases of this disease but with controversial and/or inconclusive results. This review tries to summarize data on the most representative osteoporosis candidate genes. Moreover, since recently osteoporosis and cardiovascular diseases have shown to share common physiopathological mechanisms, this review also provides information on the current understanding of osteoporosis and cardiovascular diseases common genetic bases.

Visuo-proprioceptive training reduces risk of falls in patients with multiple sclerosis

Lack of balance and falls are common and disabling symptoms of multiple sclerosis. The aim of this study was to investigate the effectiveness of a novel visuo-proprioceptive feedback training in ameliorating balance and reducing the risk of falls. Patients with multiple sclerosis with unrestricted walking ability and healthy age/sex-matched controls were recruited. After a baseline clinical evaluation, including a postural assessment in double- (stabilometric test) and single-leg stance (monopodalic test) by a computerized postural recorder device, patients were submitted to a run-in period lasting 6 weeks without any rehabilitative intervention. Two further clinical and postural evaluations before and after a 6-week period of training were performed. The training protocol provided static and dynamic exercises both in double- and single-leg stance, with and without a translating Freeman-like board. Visual feedback was shown on the computer screen during the exercises.

We recruited 40 consecutive patients and 12 controls. Patients had significantly poorer postural performances than controls. Twenty-eight patients completed the study follow-up. No significant changes in risk of falls emerged after the run-in period. A significant reduction in the median percentage of risk of falls in single-leg stance (open eyes: 39.3 versus 15.7; closed eyes: 67.3 versus 52.6; p < 0.001, respectively) were observed after rehabilitation. Moreover, an improvement in walking speed (median time: 7.4 s versus 6.3; p = 0.001) was detected in the absence of Expanded Disability Status Scale changes. We conclude that visuo-proprioceptive training improves balance and reduces falls in multiple sclerosis.