Functional limitations and occupational issues in obesity: a review

Shielded by Education? The Buffering Role of Education in the Relationships Between Changes in Mental Health and Physical Functioning Through Time Among Older Europeans

This study investigated among older Europeans how physical function limitations lead to depressive symptoms and reductions in quality of life and well-being, and vice-versa. Further examined was how years of education moderate these relationships. These objectives were pursued using a sample of Europeans aged 50+ years (N = 46,492) within waves 5 (2013) and 6 (2015) of the Survey of Health, Ageing and Retirement in Europe. The analyses employed conditional change multilevel mixed-effects linear regressions. Mental health was found to affect physical function limitations, and vice-versa. More education significantly reduced only how earlier mental health problems lead to later physical function limitations, plausibly because of the former's higher controllability. Thus highlighted are education-linked psychosocial resources' protective effects.

Going Beyond Management and Maintenance: Occupational Therapy's Role in Primary Prevention for Adults at Risk of Obesity-Is the Elephant in the Room Still the Biggest Challenge?

In this response to the Schwartz & Proffitt (2024) letter to the editor, Muntefering et al. (2023) agree that the profession has a duty to support the occupational participation of diverse individuals, including diverse body types, but also affirm that health management is an area of occupation within the practice framework.

Clinical, economic, and health-related quality of life outcomes in patients with overweight or obesity in the United States: 2016-2018

Objectives

This study aimed to estimate clinical, economic (including productivity), and health-related quality of life (HRQoL) outcomes and associated individual characteristics among adults with overweight (OW) or obesity in the United States.

Methods

This study included adult respondents with body mass index (BMI) ≥18.5 kg/m2 in the 2017-2018 National Health and Nutrition Examination Survey (NHANES) and 2016 Medical Expenditure Panel Survey. Respondents were classified according to BMI. Individual characteristics were described by BMI categories. Multivariable regression models estimated the association between BMI categories and outcomes, adjusting for individual characteristics.

Results

Nearly three-quarters (73.7%) of NHANES participants were OW or obese. Relative to Normal weight (NW), respondents with Class 3 obesity had more obesity-related complications (2.07 vs. 4.62, p < 0.001). Higher BMI was associated with significantly lower HRQoL, lower productivity, and higher healthcare expenditures as well as more frequent weight loss attempts in the previous 12 months. Weight loss surgery and prescription anti-obesity medications (AOMs) were used only by a very small proportion of individuals. Despite frequent weight loss attempts, most respondents did not achieve clinically meaningful weight loss.

Conclusions

Adults with OW or obesity experienced worse clinical, economic and HRQoL outcomes than those with NW. Better use of evidence-based obesity treatments, including prescription AOMs, should be considered to achieve more clinically meaningful weight reduction and improved outcomes in individuals with OW or obesity.

Obesity and Cancer Rehabilitation for Functional Recovery and Quality of Life in Breast Cancer Survivors: A Comprehensive Review

Obesity is a global health challenge with increasing prevalence, and its intricate relationship with cancer has become a critical concern in cancer care. As a result, understanding the multifactorial connections between obesity and breast cancer is imperative for risk stratification, tailored screening, and rehabilitation treatment planning to address long-term survivorship issues. The review follows the SANRA quality criteria and includes an extensive literature search conducted in PubMed/Medline, Web of Science, and Scopus. The biological basis linking obesity and cancer involves complex interactions in adipose tissue and the tumor microenvironment. Various mechanisms, such as hormonal alterations, chronic inflammation, immune system modulation, and mitochondrial dysfunction, contribute to cancer development. The review underlines the importance of comprehensive oncologic rehabilitation, including physical, psychological, and nutritional aspects. Cancer rehabilitation plays a crucial role in managing obesity-related symptoms, offering interventions for physical impairments, pain management, and lymphatic disorders, and improving both physical and psychological well-being. Personalized and technology-driven approaches hold promise for optimizing rehabilitation effectiveness and improving long-term outcomes for obese cancer patients. The comprehensive insights provided in this review contribute to the evolving landscape of cancer care, emphasizing the importance of tailored rehabilitation in optimizing the well-being of obese cancer patients.

The "Aging Effect" of BMI on Cardiorespiratory Fitness: A New Insight on Functional Evaluation in Obesity

Cardiorespiratory fitness (CRF) is a strong predictor of morbidity and mortality in patients with obesity. This study investigates the CRF range and its clinical determinants in patients with obesity. Moreover, a practical proposal for CRF interpretation is provided. In this study, 542 patients (69% females) with BMI ≥ 30 kg/m2 performed an incremental cardiopulmonary exercise test (CPET). Patients had a median (IQR) age of 47.0 (6.2) years with a mean BMI of 41.7 ± 6.7 kg/m2. Normal values curves of VO2peak/kg showed a median (IQR) of 20.3 (37.6) mL/min/kg. The lower-quartile threshold of VO2peak/kg was at 17.9 mL/min/kg. Analysis of covariance revealed that VO2peak/kg inversely correlates with age and BMI with a significant age × BMI interaction effect (all p < 0.0001); as BMI class increases, CRF decreases, but a smaller age-related decline in VO2peak/kg is observed. A multivariate logistic regression demonstrated that belonging to the lower quartile of VO2peak/kg was independently determined by age (OR 2.549, 95% CI 1.205-5.392, p < 0.0001) and BMI (OR 5.864, 95% CI 2.920-11.778, p < 0.0001) but not by comorbidities. At very high BMI, the effect of age on functional capacity is lower, suggesting that BMI acts as an "aging factor" on CRF. Age and BMI, but not comorbidities, are independent determinants of low VO2peak/kg.

Assessment of an IMU-Based Experimental Set-Up for Upper Limb Motion in Obese Subjects

In recent years, wearable systems based on inertial sensors opened new perspectives for functional motor assessment with respect to the gold standard motion capture systems. The aim of this study was to validate an experimental set-up based on 17 body-worn inertial sensors (Awinda, Xsens, The Netherlands), addressing specific body segments with respect to the state-of-the art system (VICON, Oxford Metrics Ltd., Oxford, UK) to assess upper limb kinematics in obese, with respect to healthy subjects. Twenty-three obese and thirty healthy weight individuals were simultaneously acquainted with the two systems across a set of three tasks for upper limbs (i.e., frontal arm rise, lateral arm rise, and reaching). Root Mean Square error (RMSE) was computed to quantify the differences between the measurements provided by the systems in terms of range of motion (ROM), whilst their agreement was assessed via Pearson's correlation coefficient (PCC) and Bland-Altman (BA) plots. In addition, the signal waveforms were compared via one-dimensional statistical parametrical mapping (SPM) based on a paired t-test and a two-way ANOVA was applied on ROMs. The overall results partially confirmed the correlation and the agreement between the two systems, reporting only a moderate correlation for shoulder principal rotation angle in each task (r~0.40) and for elbow/flexion extension in obese subjects (r = 0.66), whilst no correlation was found for most non-principal rotation angles (r < 0.40). Across the performed tasks, an average RMSE of 34° and 26° was reported in obese and healthy controls, respectively. At the current state, the presence of bias limits the applicability of the inertial-based system in clinics; further research is intended in this context.

Obesity in Adults: Position Statement of Polish Association for the Study on Obesity, Polish Association of Endocrinology, Polish Association of Cardiodiabetology, Polish Psychiatric Association, Section of Metabolic and Bariatric Surgery of the Association of Polish Surgeons, and the College of Family Physicians in Poland

Obesity in adults and its complications are among the most important problems of public health. The search was conducted by using PubMed/MEDLINE, Cochrane Library, Science Direct, MEDLINE, and EBSCO databases from January 2010 to December 2022 for English language meta-analyses, systematic reviews, randomized clinical trials, and observational studies from all over the world. Six main topics were defined in the joint consensus statement of the Polish Association for the Study on Obesity, the Polish Association of Endocrinology, the Polish Association of Cardio-diabetology, the Polish Psychiatric Association, the Section of Metabolic and Bariatric Surgery of the Society of Polish Surgeons, and the College of Family Physicians in Poland: (1) the definition, causes and diagnosis of obesity; (2) treatment of obesity; (3) treatment of main complications of obesity; (4) bariatric surgery and its limitations; (5) the role of primary care in diagnostics and treatment of obesity and barriers; and (6) recommendations for general practitioners, regional authorities and the Ministry of Health. This statement outlines the role of an individual and the adequate approach to the treatment of obesity: overcoming obstacles in the treatment of obesity by primary health care. The approach to the treatment of obesity in patients with its most common complications is also discussed. Attention was drawn to the importance of interdisciplinary cooperation and considering the needs of patients in increasing the long-term effectiveness of obesity management.

Technological Solutions for Human Movement Analysis in Obese Subjects: A Systematic Review

Obesity has a critical impact on musculoskeletal systems, and excessive weight directly affects the ability of subjects to realize movements. It is important to monitor the activities of obese subjects, their functional limitations, and the overall risks related to specific motor tasks. From this perspective, this systematic review identified and summarized the main technologies specifically used to acquire and quantify movements in scientific studies involving obese subjects. The search for articles was carried out on electronic databases, i.e., PubMed, Scopus, and Web of Science. We included observational studies performed on adult obese subjects whenever reporting quantitative information concerning their movement. The articles must have been written in English, published after 2010, and concerned subjects who were primarily diagnosed with obesity, thus excluding confounding diseases. Marker-based optoelectronic stereophotogrammetric systems resulted to be the most adopted solution for movement analysis focused on obesity; indeed, wearable technologies based on magneto-inertial measurement units (MIMUs) were recently adopted for analyzing obese subjects. Further, these systems are usually integrated with force platforms, so as to have information about the ground reaction forces. However, few studies specifically reported the reliability and limitations of these approaches due to soft tissue artifacts and crosstalk, which turned out to be the most relevant problems to deal with in this context. In this perspective, in spite of their inherent limitations, medical imaging techniques-such as Magnetic Resonance Imaging (MRI) and biplane radiography-should be used to improve the accuracy of biomechanical evaluations in obese people, and to systematically validate less-invasive approaches.

Exploring the impact of body mass change on fatigue and activity of the muscular system during daily routine

BACKGROUND

Correct body weight is one of the factors that allows you to maintain a properly functioning body. Abnormal body weight can cause muscle tissue remodelling, affecting activity and muscle fatigue. Changes in the muscular system can cause occurrence of functional limitations.

OBJECTIVE

To determine the effect of weight change on fatigue and activity of the muscular system during daily activities.

METHODS

The evaluation of musculoskeletal functioning was based on the results of computer simulations conducted in the AnyBody Modeling System. The following activities were analysed: standing, sitting down and getting up from a chair, holding and lifting an object, and walking. The simulations of the activities were carried out using averaged kinematic data, and by changing body mass in the range of 50 kg to 100 kg by increments of 2 kg, to map different nutritional status from excessive thinness to extreme obesity. Identification of loads in the musculoskeletal system was based on solving an inverse dynamics problem and then the estimation of muscle force values using static optimization. The simulation results allowed to determine the value of muscle fatigue and the level of muscle activity.

RESULTS

For activities (i.e., standing, walking, sitting down and getting up from a chair) it was observed that the value of muscle fatigue increases with increasing body mass. However, for activities that cause more load on the musculoskeletal system, i.e. lifting and holding an object, the highest value of muscle fatigue was observed in underweight individuals.

CONCLUSION

The change in body weight alters the functioning of the muscular system and thus the ability to perform activities. It was shown that in case of underweight, overweight or obese people, abnormal body weight can be the reason for occurrence of difficulties in performing the activities of lifting and holding a 20 kg object, as well as walking.

What works? A qualitative study of participants experiences of a traditional lifestyle intervention with a work focus

Purpose

Obesity is related to lower labour force participation, increased sickness absence and reduced productivity. The rehabilitation services in Norway have not had much experience introducing a work dimension into lifestyle interventions for persons with obesity. Therefore, this study aimed to evaluate one such type of intervention.

Methods

This is a qualitative study seeking to gather data on the participants’ experiences. Twenty participants were recruited from two lifestyle interventions. Intervention A, with work focus, included lectures and individual guidance from a work consultant in addition to the lifestyle intervention. Intervention B was a traditional lifestyle intervention. Data were collected by semi-structured interviews held at each stay.

Results

Seven main themes emerged and one of them pointed towards a confusion of the aim of the intervention, which was viewed as focusing on lifestyle rather than a process focused on work. Otherwise, the results showed that persons with obesity struggle with many of the same inhibiting factors as other groups with reduced work ability.

Conclusions

The application process might explain the focus on lifestyle change. Communication, guidance and support reduce barriers for lifestyle change, but work is important for general health and social well-being and a work focus may therefore be beneficial in all lifestyle interventions.

The effect of clinically elevated body mass index on physiological stress during manual lifting activities

Individuals with a body mass index (BMI) classified as obesity constitute 27.7% of U.S. workers. These individuals are more likely to experience work-related injuries. However, ergonomists still design work tasks based on the general population and normal body weight. This is particularly true for manual lifting tasks and the calculation of recommended weight limits (RWL) as per National Institute of Occupational Safety & Health (NIOSH) guidelines. This study investigates the effects of BMI on indicators of physiological stress. It was hypothesized that, for clinically elevated BMI individuals, repeated manual lifting at RWL would produce physiological stress above safety limits. A repetitive box lifting task was designed to measure metabolic parameters: volume of carbon dioxide (VCO2) and oxygen (VO2), respiratory exchange ratio (RER), heart rate (HR), and energy expenditure rate (EER). A two-way ANOVA compared metabolic variables with BMI classification and gender, and linear regressions investigated BMI correlations. Results showed that BMI classification represented a significant effect for four parameters: VCO2 (p < 0.001), VO2 (p < 0.001), HR (p = 0.012), and EER (p < 0.001). In contrast, gender only had a significant effect on VO2 (p = 0.014) and EER (p = 0.017). Furthermore, significant positive relationships were found between BMI and VCO2 (R2 = 59.65%, p < 0.001), VO2 (R2 = 45.01%, p < 0.001), HR (R2 = 21.86%, p = 0.009), and EER (R2 = 50.83%, p < 0.001). Importantly, 80% of obese subjects exceeded the EER safety limit of 4.7 kcal/min indicated by NIOSH. Indicators of physiological stress are increased in clinically elevated BMI groups and appear capable of putting these individuals at increased risk for workplace injury.

Childhood Obesity and Incorrect Body Posture: Impact on Physical Activity and the Therapeutic Role of Exercise

Obesity is associated with various dysfunctions of the organism, including musculoskeletal problems. In this narrative review, we aim to consider postural problems in children and adolescents with obesity, focusing on the relationship with its negative impact on physical activity, and to discuss the role of exercise as a therapeutic approach. The body reacts to excess weight by changing its normal balance, and the somatosensory system of children with obesity is forced to make major adjustments to compensate for postural problems. These adaptations become more difficult and tiring if activities that require continuous postural changes and multi-tasking are engaged in. Children with obesity have less body control and functional ability due to the excess fat mass, which reduces their ability to perform motor skills and take part in physical activity. Appropriate early interventions for the management of musculoskeletal problems are needed to ensure healthy growth and to prevent comorbidities in childhood and adulthood. Prevention programs must be based not only on the reduction of body weight but also on the definition of correct postural habits from an early age. It is equally important to provide correct information on the types and doses of physical activity that can help prevent these problems.

Determination of Patient Acceptable Symptom State for the Oswestry Disability Index Score in Patients Who Underwent Minimally Invasive Discectomy for Lumbar Disc Herniation: 2-Year Follow-up Data from a Randomized Controlled Trial

OBJECTIVE

We aim to determinate the patient acceptable symptom state (PASS) for the Oswestry Disability Index (ODI) score in patients undergoing minimally invasive discectomy for the treatment of lumbar disc herniation.

METHODS

A post hoc analysis of prospectively collected, 2-year follow-up data was conducted. The anchor for determination of PASS was the European Quality of Life Visual Analog Scales question, and the Pearson correlation test was performed to evaluate its validity. The receiver operating characteristics (ROC) curve analysis was conducted to determine the PASS thresholds for ODI and its discriminative ability assessment. Sensitivity analyses were also carried out for alternative definition of PASS, different follow-up periods, and different subgroups.

RESULTS

A total of 222 patients (92.1%) completed the 2-year follow-up, 92.8% of whom considered their state to be acceptable. The area under the ROC curve (AUC) were all >0.8, indicating a high discriminative ability. The PASS threshold for the ODI was suggested to be 5 at 6 months (AUC: 0.80; sensitivity: 79.0%, specificity: 73.7%) and 2 years (AUC: 0.98; sensitivity: 90.3%, specificity: 100%) postoperatively. Despite some variations found in different body mass index and baseline ODI subgroups, sensitivity analysis showed that the above-mentioned threshold was robust.

CONCLUSIONS

An ODI of 5 was noted to be the PASS threshold for patients received minimally invasive discectomy for the treatment of LDH. This ODI threshold was robust, and therefore recommended as the ultimate goal of minimally invasive treatment for LDH, which can help to present results of clinical research at an individual level.

Reference equations for the six-minute walking distance in obese Chinese subjects more than 40 years old

BACKGROUND

Studies have shown that the reference equations for the six-minute walking distance (6MWD), which were mainly derived from healthy, normal-weight people, are not suitable for individuals with obesity. The main purpose of this study was to establish reference equations for the 6MWD in obese Chinese subjects.

METHODS

In our study, a total of 214 individuals with obesity performed the six-minute walking tests (6MWTs) according to the American thoracic society (ATS) guidelines, and the longer 6MWD was used for further analysis. The reference equations for the 6MWD were developed using stepwise multiple regression analysis. The newly established equations for the 6MWD were compared to the existing prediction equations.

RESULTS

The mean 6MWD for the cohort was 523 ± 56 m. We found that the reliability of two 6MWTs was good. Age and BMI were identified as independent factors, and explained 31% and 27% of the variance in the 6MWD for the male and female participants, respectively. Thus, the reference equations reported in the previous studies did not accurately predict the 6MWD in our subjects.

CONCLUSION

Our study was the first to describe the 6MWD in obese Chinese subjects and to propose new predictive equations. These established equations can improve the assessment of the health of obese Chinese patients whose exercise capacity is affected by the disease.

LEVEL OF EVIDENCE

III, Cohort study.

Two-minute walk distance reference equations for middle-aged and elderly Chinese individuals with obesity

Background and objective

While the six-minute walk test (6MWT) is often used to assess exercise capacity, the less well-known two-minute walk test (2MWT) is more feasible for some patients. In previous studies, we developed reference equations for the two-minute walk distance (2MWD) for healthy Chinese adults. However, our study did not recruit people with obesity, and the reference equations did not apply to participants with a body mass index (BMI) > 30 kg/m². The main objective of this study was to establish reference equations for the 2MWD among middle-aged and elderly Chinese individuals with obesity.

Methods

A total of 295 individuals were recruited. The participants underwent two 2MWTs, with the longer of the two 2MWDs used for further analyses. The reference equations for the 2MWD were developed using stepwise multiple regression analysis. The newly established equations for the 2MWD were then compared with the existing equations.

Results

The mean 2MWD of the participants was 176±20 m. Age and BMI were identified as independent factors that influenced the 2MWD and explained 28% and 32% of the variance in walking distance for the male and female groups, respectively. The reference equations for the 2MWD were as follows:

Conclusion

This study resulted in the development of reference equations for predicting 2MWD among middle-aged and elderly Chinese people with obesity. These equations will be a clinically valuable tool for evaluating functional capacity, determining prognoses and monitoring treatment in middle-aged and elderly Chinese people with obesity.

Effectiveness of Motivational Interviewing in Managing Overweight and Obesity : A Systematic Review and Meta-analysis

BACKGROUND

Motivational interviewing (MI) is potentially useful in management of overweight and obesity, but staff training and increased delivery time are barriers, and its effectiveness independent of other behavioral components is unclear.

PURPOSE

To assess the independent contribution of MI as part of a behavioral weight management program (BWMP) in controlling weight and improving psychological well-being.

DATA SOURCES

6 electronic databases and 2 trial registries, searched from database inception through 24 September 2021.

STUDY SELECTION

Randomized controlled trials in adults or adolescents aimed at weight loss or maintenance and comparing programs incorporating MI versus interventions without MI.

DATA EXTRACTION

Two reviewers independently screened studies, extracted data, and assessed risk of bias. Outcomes included weight, anxiety, depression, quality of life, and other aspects of psychological well-being. Pooled mean differences or standardized mean differences were obtained using random- and fixed-effects meta-analyses.

DATA SYNTHESIS

Forty-six studies involving 11 077 participants, predominantly with obesity, were included. At 6 months, BWMPs using MI were more effective than no/minimal intervention (-0.88 [95% CI, -1.27 to -0.48] kg; I ² = 0%) but were not statistically significantly more effective than lower-intensity (-0.88 [CI, -2.39 to 0.62] kg; I ² = 55.8%) or similar-intensity (-1.36 [CI, -2.80 to 0.07] kg; I ² = 18.8%) BWMPs. At 1 year, data were too sparse to pool comparisons with no/minimal intervention, but MI did not produce statistically significantly greater weight change compared with lower-intensity (-1.16 [CI, -2.49 to 0.17] kg; I ² = 88.7%) or similar-intensity (-0.18 [CI, -2.40 to 2.04] kg; I ² = 72.7%) BWMPs without MI. Studies with 18-month follow-up were also sparse; MI did not produce statistically significant benefit in any of the comparator categories. There was no evidence of subgroup differences based on study, participant, or intervention characteristics. Too few studies assessed effects on psychological well-being to pool, but data did not suggest that MI was independently effective.

LIMITATIONS

High statistical heterogeneity among studies, largely unexplained by sensitivity and subgroup analyses; stratification by comparator intensity and follow-up duration resulted in pooling of few studies.

CONCLUSION

There is no evidence that MI increases effectiveness of BWMPs in controlling weight. Given the intensive training required for its delivery, MI may not be a worthwhile addition to BWMPs.

PRIMARY FUNDING SOURCE

National Institute for Health Research Biomedical Research Centre. (PROSPERO: CRD42020177259).

Designing and Usability testing of a New Prototype Active Footrest for Knee Extension Exercise Among Office Workers

OBJECTIVES

The active factor along with light exercise can reduce static muscle work and increase muscle flexibility and endurance. Accordingly, this study aimed to design and prototype a new active footrest, implemented in conventional sitting workstations and to test its usability among office workers.

METHODS

The steps taken to design and prototype the active footrest were a) selection of an exercise appropriate for goals of ergonomic interventions, b) idea development, c) selection of the best conceptual design, d) design with SOLIDWORKS version 2016 software, and e) fabrication of a prototype. Afterward, the usability of the active footrest prototype was assessed among 20 office workers (10 females) using field data by the System Usability Scale.

RESULTS

Upon the completion of the design steps, the active footrest prototype was prototyped by taking into account design criteria (e.g. functionality, inclusive design, easy application, and reduction of additional body movement), anthropometric data and mechanical properties. The participants rated the usability of the active workstation as 89 ± 8.21 (out of 100) and indicating good usability results.

CONCLUSION

In this study, an active footrest was designed and prototyped to perform knee extension exercise with the capability of being implemented in conventional sitting workstations.

Can BMI be a predictor of perioperative complications in Head and Neck cancer surgery?

<b>Introduction:</b> The effect of BMI on development of perioperative complications in head and neck cancer surgeries is not welldefined. </br></br> <b> Aim:</b> This study aims to evaluate the effect of body mass index (BMI) on the development of surgical complications during the perioperative period in head and neck carcinoma (HNC) patients. </br></br> <b>Materials and methods:</b> This study was conducted from 2019 to 2020. Electronic medical records of 210 patients undergoing major (clean-contaminated) surgeries were analysed. Chi-square test or Fisher exact test for determining association in categorical data and independent T-test or Mann-Whitney U test for comparison between the presence of complications and relation with continuous clinical parameters were used. </br></br> <b>Results:</b> The majority of patients were within normal-weight range (68.57%). Only 12.85% of patients had BMI under 18.5 kg/m2 and 18.57% of patients had BMI equal to or more than 25 kg/m2. Coexisting comorbidities were present in 48.7% of patients with BMI of more than 25 kg/m2. Major and minor complications were present in 10.5% and 16.7% of all patients, respectively. Surgical site infections were present in 18.1% of patients. There was no statistical difference in the rate of complications (major, minor and SSI) in underweight, normal weight and overweight categories. The complications were significantly associated with the extent of surgery (P = 0.00413) and blood loss of more than 775 mL (P-value 0.005). </br></br> <b> Conclusions:</b> In conclusion, the rate of surgical complications in head and neck onco-surgeries is not related to BMI of the patients. The perioperative management of these patients might require some modification due to co-existing comorbidities, but the overall impact on the development of complications could not be proven in this study.

Higher body mass index and body fat percentage correlate to lower joint and functional strength in working age adults

As the prevalence of obesity grows worldwide, it becomes an increasing concern in working populations. Ergonomists are faced with the challenge of accommodating workplace layouts to include this worker demographic. This study investigated the relationship between shoulder and low back isometric joint strengths across body mass index (BMI) groups. Additionally, relationships between body fat percentage (BF%), absolute strength, and strength normalized to body mass were examined. Ninety, healthy, working age participants performed 11 functional and isometric joint strength exertions. BMI group influenced normalized strength, as the obese 2+ (BMI >35.0) group had up to 63.1% lower joint strength than all other BMI groups (p < 0.05). Significant strong to moderate negative linear relationships existed between BF% and normalized strength for both males and females, and relationships were stronger for females. These strength deficits highlight the importance of considering body composition during ergonomics analyses and configuration of occupational tasks.

The association between manual handling operations and pain in the hands and arms in the context of the 2018 BIBB/BAuA Employment Survey

BACKGROUND

Manual handling operations (MHO) are tasks performed by hand that require repetitive and forceful hand and arm movements. MHO are currently performed in many workplaces in skilled and unskilled jobs in the production and service sectors. MHO are considered as work-related health risk factors. The relationship between MHO and the occurrence of disorders of the upper extremities has been established. MHO can cause diseases such as tenosynovitis or carpal tunnel syndrome. This study aims to assess the current prevalence of MHO in the German workforce and to evaluate the relationship between MHO and the occurrence of hand and arm complaints.

METHODS

The analysis was based on the German 2018 BIBB/BAuA Employment Survey. For this analysis we included subjects aged between 16 and 66 who work at least 35 h per week. The self-reported frequency of MHO (never; rarely; sometimes; often) was considered as the exposure of interest and was stratified by gender and occupation. Prevalence ratios (PR) were used to report the relationship between MHO and self-reported pain in the hands and arms (robust log-linear Poisson regression). Adjustments were made for age, gender, actual weekly working hours, psychosocial workload, and other physical workloads. The regression analyses considered complete cases.

RESULTS

The analyses included 14,299 employees. Frequent MHO were reported by 32.6% of men and 31.1% of women. These workloads were often reported by respondents who work in the agricultural sector (men: 70.1%; women: 79.0%), in unskilled (men: 59.4%; women: 66.9%), and skilled manual occupations (men: 72.7%; women: 66.7%). A higher frequency of self-reported MHO was associated with a higher prevalence of hand complaints (PR 2.26 CI 2.00-2.55 "often" vs. "never" = ref.) as well as arm pain (PR 1.73 CI 1.55-1.92 for "often" vs. "never" = ref.).

CONCLUSION

MHO are still frequent in many occupations. The shown association between MHO and pain in the hands and arms demonstrates the importance of MHO in the current German workforce and the necessity to further develop prevention strategies.

Obesity and Work-Related Injuries Among Farmers in Kentucky, Tennessee, and West Virginia

BACKGROUND

Obesity is a recognized risk factor for work-related injuries (WRI). Despite the inherent safety hazards associated with farm work, research on obesity among farmers is limited giving little guidance to occupational health providers on obesity as a risk factor in farm WRI. This study evaluated the association between obesity and farm WRI.

METHODS

Cross-sectional data were collected from farmers (n = 100) in Kentucky, Tennessee, and West Virginia. Data included a survey (demographic data, farm factors, health indicators, occurrences of work-related injuries consistent with the definition of Occupational Safety and Health Administration [OSHA] recordable injuries) and direct anthropometric measures (height, weight, and waist circumference). Logistic regression was used to model any work-related injury, injuries consistent with the definition of OSHA recordables (herein called OSHA-recordable injuries), and recurrent injuries occurring during farm work performance on body mass index (BMI) and waist circumference.

FINDINGS

Twenty-five percent of the participants reported any injuries, and 18% reported OSHA-recordable injuries. Farmers with a BMI ≥30 kg/m² had 3 times the risk for OSHA-recordable injuries and 5 times the risk for recurrent injuries. No significant relationship was identified between waist circumference and farm WRI.

CONCLUSION

This study provides evidence that increased BMI is a safety risk for farmers. Prospective studies with a larger sample are needed. Occupational health nurses and providers should educate farmers on the potential safety risk of obesity and implement weight management programs addressing obesity in farmers.

The patient acceptable symptom state for the Oswestry Disability Index following single-level lumbar fusion for degenerative spondylolisthesis

BACKGROUND CONTEXT

The patient acceptable symptom state (PASS) is a valuable tool for interpreting patient-reported outcomes. Previous studies have attempted to define the PASS in a heterogenous cohort with various lumbar spinal disorders and surgical procedures.

PURPOSE

We aimed to determine the PASS threshold for the Oswestry Disability Index (ODI) specifically for patients undergoing lumbar fusion for spondylolisthesis-associated functional disability.

STUDY DESIGN

Retrospective review of prospectively collected registry data.

PATIENT SAMPLE

There were 692 patients who underwent primary single-level minimally invasive transforaminal lumbar interbody fusion for degenerative spondylolisthesis between 2006 and 2014.

OUTCOME MEASURES

The ODI was collected pre-operatively, at 6 months and 2 years postoperatively. An anchor question was adapted from the NASS questionnaire, "How would you rate the overall results of your treatment?" while a validation question was taken from the same questionnaire, "Has the surgery for your back condition met your expectations so far?"

METHODS

Responses to the anchor question were used to determine whether a PASS was achieved. Receiver operating characteristics curve analysis was performed to assess the ability of the ODI to discriminate between an acceptable/unacceptable symptom state as well as to define PASS thresholds. Sensitivity analyses were performed for different follow-up periods (6 months, 2 years), subgroups (by age, gender, BMI, and comorbidity burden), baseline ODI tertiles, and an alternate definition of PASS.

RESULTS

In total, 529 of 692 (76%) patients completed 2-year follow-up, of which, 89% considered their symptom state to be acceptable. Areas under the curve (AUC) ranged from 0.81 to 0.90 for all receiver operating characteristics analyses, indicating that the ODI had an excellent discriminative ability. The PASS threshold was ≤18.09 at 6 months (AUC 0.81, sensitivity 77%, specificity 72%) and ≤15.27 at 2 years (AUC 0.86, sensitivity 79%, specificity 79%). These thresholds proved to be robust in the sensitivity analyses, showing minimal variation across different patient subgroups and baseline score tertiles.

CONCLUSIONS

Patients with an ODI of ≤15.27 can be considered to have achieved a PASS after lumbar fusion for degenerative spondylolisthesis. These findings will help surgeons to contextualize a patient's functional recovery after lumbar spine surgery and enable researchers to define clinically relevant benchmarks when designing trials utilizing the ODI.

Changes in symmetry during gait in adults with Prader-Willi syndrome

Most studies on locomotion of individuals with the Prader-Willi Syndrome (PWS) have been performed in a laboratory setting using quantitative motion analysis. Recently, wireless inertial sensors have been successfully employed for gait analysis in different pathological states with the advantages of reproducing a testing condition very close to those encountered in daily living. Using such devices, it is possible not only to characterize the conventional spatio-temporal parameters, but also extract information on further less conventional metrics, such as the harmonic ratio (HR), a measure of step-to-step symmetry based on trunk acceleration processing. In the present study, this technique was used to quantify gait parameters during level walking in 20 adults with PWS who were compared to 20 unaffected individuals. While no differences between the two groups were found in terms of spatio-temporal parameters, individuals with PWS exhibited significantly reduced values of HR in the antero-posterior and vertical directions. Such results, which indicate a poorer gait symmetry in PWS, suggest that upper body accelerations, as well as HR, provide novel information on gait in people with PWS that could not be extracted from spatio-temporal parameters only.

Factors associated with health-related quality of life in a working population in Singapore

OBJECTIVES

This study aimed to evaluate the determinants of health-related quality of life (HRQoL) among workers in Singapore.

METHODS

We analysed data from a cross-sectional study of 464 participants from 4 companies in Singapore. Physical and mental components of HRQoL were assessed using the Short-Form 36 version 2.0 survey. A generalized linear model was used to determine factors associated with the physical component summary (PCS) and mental component summary (MCS) scores of HRQoL.

RESULTS

The overall mean PCS and MCS scores were mean±standard deviation 51.6±6.7 and 50.2±7.7, respectively. The scores for subscales ranged from 62.7±14.7 for vitality to 83.5±20.0 for role limitation due to emotional problems. Ethnicity, overweight/obesity, and years working at the company were significantly associated with physical HRQoL, and age and stress at work were significantly associated with mental HRQoL. Moreover, sleep quality was significantly associated with both physical and mental HRQoL.

CONCLUSIONS

These findings could help workplaces in planning strategies and initiatives for employees to maintain a worklife balance that encompasses their physical, emotional, and social well-being.

Cardiovascular and Psychophysical Response to Repetitive Lifting Tasks in Women

Background

Understanding the cardiovascular and psychophysical demands of repetitive lifting tasks is important in job design strategies. This study determined the cardiovascular (oxygen consumption (VO₂) and heart rate (HR) and psychophysical response to repetitive lifting tasks in women.

Methods

Ten female (age 27 ± 5 yrs) participants transferred 11.4, 15.9, and 20.5 kg weights back and forth from a rung 40.6 cm high to a rung 156.2 cm high. Rungs were 195.6 cm apart horizontally. Three, 10 minute bouts (1 = 11.4 kg; 2 = 15.9 kg; 3 = 20.5 kg) were performed at 6 lifts per minute. Cardiovascular and psychophysical (rating of perceived exertion, RPE) parameters were monitored throughout the bouts. VO₂max and HRmax were determined via a maximal treadmill test.

Results

VO₂, HR, and RPE were significantly different between each work bout (p < 0.01), with each outcome variable increasing as load increased. VO₂max and HRmax equaled 46.5 ± 7.5 mL·kg⁻¹·min⁻¹ and 191 ± 11 bpm, respectively. Work at 11.4 kg was performed at 38% VO₂max and 63% HRmax; at 15.9 kg at 41% VO₂max and 72% HRmax; and at 20.5 kg at 49% VO₂max and 81% HRmax. RPE at 11.4, 15.9, and 20.5 kgs were: 8.4 ± 1.6, 11.4 ± 1.9, and 15.0 ± 2.2.

Conclusion

During these repetitive lifting tasks, metabolic cost and perceived exertion increased with weight lifted; average work intensity ranged from 63 to 81% of HRmax and 38 to 49% of VO₂max. Results have important implications in relation to job pacing and design, and worksite health promotion strategies aimed at reducing work place injury.

Evaluation of Whole-Body Vibration Exercise on Neuromuscular Activation Through Electromyographic Pattern of Vastus Lateralis Muscle and on Range of Motion of Knees in Metabolic Syndrome: A Quasi-Randomized Cross-Over Controlled Trial

Metabolic syndrome (MetS) is related to overweight and obesity, and contributes to clinical limitations. Exercise is used for the management of MetS individuals, who are often not motivated to perform this practice. Whole body vibration exercise (WBVE) produces several biological effects, besides being safe, effective, and feasible for MetS individuals. This pseudo-randomized and cross-over controlled trial study aimed to analyze the effects of WBVE on MetS individuals’ neuromuscular activation using the surface electromyography (sEMG) pattern (root mean square (RMS)) of the vastus lateralis (VL) muscle and on the range of motion (ROM) of the knees. Participants (n = 39) were allocated to two groups: the treatment group (TG), which was exposed to WBVE, and the control group (CG). WBVE interventions were performed twice a week, for a period of 5 weeks. ROM and sEMG were analyzed at baseline, after the first session, and before and after the last session. sEMG (%RMS) significantly increased in the acute effect of the last session of WBVE (108.00 ± 5.07, p < 0.008, right leg; 106.20 ± 3.53, p < 0.02, left leg) compared to the CG. ROM did not significantly change in TG or CG. In conclusion, 5 weeks of WBVE exerted neuromuscular effects capable of increasing VL muscle RMS in individuals with MetS, this effect being potentially useful in the physical rehabilitation of these individuals.

Analysis of the Association between Eating Behaviors and Weight Loss after Laparoscopic Sleeve Gastrectomy

SETTING

In a private medical center, 300 patients who underwent a laparoscopic sleeve gastrectomy (LSG) were classified into 4 groups according to their eating behaviors (EB) preoperatively. During a 3-year postoperative follow-up, dietary changes in relation to weight loss were studied.

OBJECTIVES

To explore the influence of abnormal EB on the outcome of sleeve gastrectomy.

BACKGROUND

Patients with morbid obesity often suffer from abnormal EB. After LSG, the outcome depends largely on improvement of the feeding behaviors acquired.

METHODS

This prospective study includes 300 patients who underwent LSG from 2013 to 2014, divided into the following 4 groups: binge eaters, snack eaters, sweet eaters, and volume eaters.

RESULTS

The average age was 41.65 years, the ratio of male to females was 1 to 2. The average baseline body mass index (BMI) was 42.02. After 3 years, no significant change was found in the number of binge eaters (p = 0.396), but there was an 8.9% increase in snack eaters (p < 0.001), a 12.9% increase in sweet eaters (p < 0.001), and 17.2% increase in healthy eating habits (p < 0.001). Sixty-five (24.8%) patients did not experience changes in their eating patterns. However, after surgery, 24.6% of the patients continued with the same EB and 125 (49.5%) patients changed from one EB to another unhealthy EB. Weight loss, measure as ΔBMI, was similar in each group after 3 years, with a mean BMI of 29.8. When eating habits were related to different features such as gender, sports practice, type of work, smoking, marital status, comorbidities, no influence on the operative results were found.

CONCLUSION

LSG promotes the reduction of overeaters; however, it promotes a switch between other unhealthy EB. The significant increase in snack eaters and sweet eaters is outstanding, although it did not affect weight loss in the midterm follow-up. Worsening of eating habits after LSG is a common fact.

Relative Strength at the Hip, Knee, and Ankle Is Lower Among Younger and Older Females Who Are Obese

Background and Purpose:

The mobility of individuals who are obese can be limited compared with their healthy weight counterparts. Lower limb strength has been associated with mobility, and reduced strength may contribute to mobility limitation among individuals who are obese. However, our understanding of the effects of obesity on lower limb strength is limited. The purpose of this study was to investigate the effects of obesity and age on extension and flexion strength at the hip, knee, and ankle.

Methods:

Using a cross-sectional design, 10 younger (18-30 years) healthy weight (body mass index = 18-24.9 kg/m²), 10 younger obese (body mass index >30 kg/m²), 10 older (65-80 years) healthy weight, and 10 older obese female participants performed isokinetic maximum voluntary contractions in ankle plantar flexion (PF), ankle dorsiflexion (DF), knee extension (KE), knee flexion (KF), hip extension (HE), and hip flexion (HF).

Results and Discussion:

Absolute strength among obese participants was 29% higher in DF (P = .002), 27% higher in KE (P = .004), and 23% higher in HF (P = .001), compared with healthy weight participants. Strength relative to body mass among obese participants was 31% lower in PF (P < .001), 14% lower in DF (P = .042), 16% lower in KE (P = .015), 27% lower in KF (P < .001), 29% lower in HE (P < .001), and 19% lower in HF (P = .001).

Conclusions:

Obese females exhibited lower relative strength at the ankle and hip, similar to the lower relative strength exhibited at the knee. Obese females also exhibited higher absolute strength, but only for 3 of 6 lower limb exertions investigated. This lack of uniformity across the 6 exertions is likely due to the still unclear underlying biomechanical mechanism responsible for these strength differences, which may also be influenced by aging. The effects of obesity on lower limb strength were also generally consistent between the 2 age groups investigated.

Cardiometabolic Risk Factors among Healthcare Workers: A Cross-Sectional Study at the Sefwi-Wiawso Municipal Hospital, Ghana

BACKGROUND

There is a dearth of information about the burden of cardiometabolic risk factors among the Ghanaian health workforce in the Western Region. This study sought to determine the prevalence of cardiometabolic risk factors among healthcare workers at the Sefwi-Wiawso Municipal Hospital in the Western Region of Ghana.

MATERIALS AND METHODS

A hospital-based cross-sectional study involving 112 employees of the Sefwi-Wiawso Municipal Hospital was conducted. The cardiometabolic risk variables assessed were obesity, hypertension, dyslipidaemia, and diabetes. Sociodemographic parameters were also captured. The prevalence of hypertension and obesity was determined using the JNC VII panel and WHO BMI criteria for obesity classifications. Blood lipids and glucose concentrations were evaluated using standard methods.

RESULTS

The prevalence of hypertension and prehypertension was 16.07% and 52.68%, respectively. About 38.39% of participants were overweight, and 12.50% were obese. Atherogenic dyslipidaemia was 26.79%, whereas prediabetes glycaemic levels and diabetes incidence were 5.41% and 4.50%, respectively. Fifty percent (50.00%) of participants presented at least one cardiometabolic risk factor. Aging and adiposity were associated with increasing cardiometabolic risk.

CONCLUSION

Cardiometabolic risk factors are prevalent among healthcare providers in Sefwi-Wiawso. The cardiometabolic dysregulation observed among this cohort of healthcare professionals may be modulated by age and adiposity.

The Relationship Between BMI and Work-Related Musculoskeletal (MSK) Injury Rates is Modified by Job-Associated Level of MSK Injury Risk

OBJECTIVE

The aim of this study was to examine the relationship between body mass index (BMI) and occupational musculoskeletal (MSK) injury rates, and the statistical interaction between BMI and occupational exposure to MSK hazards (measured by level of MSK injury risk based on job category).

METHODS

Using 17 years of data from 38,214 university and health system employees, multivariate Poisson regression modeled the interaction between BMI and MSK injury risk on injury rates.

RESULTS

A significant interaction between BMI and MSK injury risk was observed. Although the effect of BMI was strongest for 'low' MSK injury risk occupations, absolute MSK injury rates for 'mid'/'high' MSK injury risk occupations remained larger.

CONCLUSIONS

To address the occupational MSK injury burden, initiatives focused on optimal measures of workers' BMI are important but should not be prioritized over (or used in lieu of) interventions targeting job-specific MSK injury hazards.

Cognitive behavioral therapy to aid weight loss in obese patients: current perspectives

Obesity is a chronic condition associated with risk factors for many medical complications and comorbidities such as cardiovascular diseases, some types of cancer, osteoarthritis, hypertension, dyslipidemia, hypercholesterolemia, type-2 diabetes, obstructive sleep apnea syndrome, and different psychosocial issues and psychopathological disorders. Obesity is a highly complex, multifactorial disease: genetic, biological, psychological, behavioral, familial, social, cultural, and environmental factors can influence in different ways. Evidence-based strategies to improve weight loss, maintain a healthy weight, and reduce related comorbidities typically integrate different interventions: dietetic, nutritional, physical, behavioral, psychological, and if necessary, pharmacological and surgical ones. Such treatments are implemented in a multidisciplinary context with a clinical team composed of endocrinologists, nutritionists, dietitians, physiotherapists, psychiatrists, psychologists, and sometimes surgeons. Cognitive behavioral therapy (CBT) is traditionally recognized as the best established treatment for binge eating disorder and the most preferred intervention for obesity, and could be considered as the first-line treatment among psychological approaches, especially in a long-term perspective; however, it does not necessarily produce a successful weight loss. Traditional CBT for weight loss and other protocols, such as enhanced CBT, enhanced focused CBT, behavioral weight loss treatment, therapeutic education, acceptance and commitment therapy, and sequential binge, are discussed in this review. The issue of long-term weight management of obesity, the real challenge in outpatient settings and in lifestyle modification, is discussed taking into account the possible contribution of mHealth and the stepped-care approach in health care.

Validation of the Italian version of the Laval questionnaire: health-related quality of life in subjects with obesity

Background

Obesity is associated to increased risk of metabolic comorbidity as well as increased mortality. Notably, obesity is also associated to the impairment of the psychological status and of quality of life.

Only three questionnaires are available in the Italian language evaluating the health-related quality of life in subjects with obesity.

The aim of the present study was to test the validity and reliability of the Italian version of the Laval Questionnaire.

Methods

The original French version was translated into Italian and back-translated by a French native speaker. 273 subjects with obesity (Body Mass Index ≥ 30 kg/m²) were enrolled; the Italian version of the Laval Questionnaire and the O.R.Well-97 questionnaire were administered in order to assess health- related quality of life. The Laval questionnaire consists of 44 items distributed in 6 domains (symptoms, activity/mobility, personal hygiene/clothing, emotions, social interaction, sexual life). Disability and overall psychopathology levels were assessed through the TSD-OC test (SIO test for obesity correlated disabilities) and the SCL-90 (Symptom Checklist-90) questionnaire, respectively. To verify the validity of the Italian version, the analysis of internal consistency, test-retest reliability, and construct validity were performed.

Results

The observed proportion of agreement concordance of results was 50.2% with Cohen’s K = 0.336 (CI 95%: 0.267–0.404), indicating a fair agreement between the two tests.

Test-retest correlation was statistically significant (ρ = 0.82; p < 0.01); validity (standardized Chronbach’s alpha) was considered reliable (α > 0.70). The analysis of construct validity showed a statistically significant association in terms of both total score (ρ = −0.66) and scores at each single domain (p < 0.01). A high correlation (p < 0.01) was observed between Laval questionnaire total and single domain scores and other related measures (Body Mass Index, TSD-OC scores, SCL-90 global severity index), revealing a high construct validity of the test.

Conclusions

The Italian version of the Laval Questionnaire is a valid and reliable measure to assess the health-related quality of life in subjects with obesity.

Risk assessment of manual handling operations at work with the key indicator method (KIM-MHO) - determination of criterion validity regarding the prevalence of musculoskeletal symptoms and clinical conditions within a cross-sectional study

Background

Manual handling operations (MHO) are known to be risk factors for work-related upper limb disorders (WRULDs), e.g. symptoms and conditions such as carpal tunnel syndrome. To estimate the risk of WRULDs, a Key Indicator Method (KIM) for the risk assessment of MHO was developed. The method was validated in regard to different criteria, including face validity, criterion validity, reliability and further aspects concerning utility. This paper describes the KIM-MHO and criterion validity of this method with reference to prevalence of musculoskeletal disorders (MSDs).

Methods

A cross-sectional sample of 643 employees exposed to MHO was compared to a reference group of 804 unexposed subjects predominantly working at visual display terminals. The Nordic Questionnaire and a standardized clinical examination were used to obtain the 7-day and 12-months prevalence of symptoms and clinical conditions of the musculoskeletal system. Job specific exposure levels to MHO were assessed by ergonomists using the KIM-MHO. The resulting risk scores were categorized into risk categories 1 - low risk (reference group), 2 - increased risk, 3 - highly increased risk, and 4 - high risk. Log-linear Poisson regression models were applied to obtain adjusted prevalence ratios (PR) with 95%-confidence intervals.

Results

The 7-day prevalence of symptoms for subjects in risk category 3 compared to risk category 1 was significant for the regions shoulder [women (w): PR 1.8 (1.2–2.7), men (m): PR 2.3 (1.2–4.4)], elbow [w: PR 3.3 (1.5–7.2), m: PR 2.4 (0.8–7.3)], and hand/wrist [w: PR 3.0 (1.7–5.3), m: PR 5.5 (2.7–11.3)]. The 7-day prevalence of symptoms for risk category 4 was also significant for the regions shoulder [w: PR 1.9 (1.3–2.8), m: PR 1.9 (1.3–2.7)], elbow [w: PR 4.5 (2.3–8.7), m: PR 3.3 (2.1–5.4)], and hand/wrist [w: PR 4.2 (2.6–6.9), m: PR 5.5 (3.5–8.5)]. The 12-months prevalence in these joint regions show comparable increases in the risk categories 3 and 4.

Conclusions

The KIM-MHO is valid in regard to criterion validity. The hypothesis could be confirmed, that high risk scores were associated with an increased prevalence of symptoms and clinical conditions especially in the shoulder, elbow and hand/wrist regions among employees exposed to MHO.

Electronic supplementary material

The online version of this article (doi:10.1186/s12891-017-1542-0) contains supplementary material, which is available to authorized users.

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.

Age, human performance, and physical employment standards

The proportion of older workers has increased substantially in recent years, with over 25% of the Canadian labour force aged ≥55 years. Along with chronological age comes age-related declines in functional capacity associated with impairments to the cardiorespiratory and muscular systems. As a result, older workers are reported to exhibit reductions in work output and in the ability to perform and/or sustain the required effort when performing work tasks. However, research has presented some conflicting views on the consequences of aging in the workforce, as physically demanding occupations can be associated with improved or maintained physical function. Furthermore, the current methods for evaluating physical function in older workers often lack specificity and relevance to the actual work tasks, leading to an underestimation of physical capacity in the older worker. Nevertheless, industry often lacks the appropriate information and/or tools to accommodate the aging workforce, particularly in the context of physical employment standards. Ultimately, if appropriate workplace strategies and work performance standards are adopted to optimize the strengths and protect against the vulnerability of the aging workers, they can perform as effectively as their younger counterparts. Our aim in this review is to evaluate the impact of different individual (including physiological decline, chronic disease, lifestyle, and physical activity) and occupational (including shift work, sleep deprivation, and cold/heat exposure) factors on the physical decline of older workers, and therefore the risk of work-related injuries or illness.

Obesity is associated with more disability at presentation and after treatment in low back pain but not in neck pain: findings from the OIOC registry

BACKGROUND

The influence on the treatment response in patients with low back pain (LBP) and neck pain (NP) is unknown. The aim of the study was to investigate the influence of body weight in patients with low back pain (LBP) and neck pain (NP) on baseline and end of treatment disability.

METHODS

Cross-sectional analysis of baseline factors. Longitudinal analysis of prospectively collected patient information at an outpatient physical therapy registry (data from June 2010 to December 2012). WHO-BMI classification was used: underweight, lean, overweight, obesity class I, obesity class II and III. The influence of body weight and a predefined set of confounders was analyzed by multiple regression models.

RESULTS

In LBP, disability increased with increasing BMI [lean = reference, obesity class I Beta 5.41 (95 % CI 0.75; 10.07), obesity class II-III Beta 7.58 (95 % CI 2.13; 13.03)]. Compared to lean patients, disability after treatment improved in overweight subjects [Beta -3.90 (95 % CI -7.4; -0.41)] but not in subjects with obesity class II-III [Beta 3.43 (95 % CI -3.81; 10.68)]. There were insufficient patients in the sample with severe obesity and therefore this trend has to be confirmed. The likelihood for meaningful important change (MID) was similar in all BMI subgroups. For patients with NP, BMI was not associated with baseline disability, and did not predict end of treatment disability or the likelihood of a MID. These findings must be interpreted with caution as BMI subgroups did not meet the required sample size.

CONCLUSION

Overweight and obesity are associated with higher levels of disability before treatment in LBP patients, but not in NP. In severely obese patients class II-III with LBP the rate of MID was lowest indicating that these patients experienced the least treatment response compared to the other groups. Further studies should address the impact of severe obesity on the prognosis of LBP. In patients with LBP, severe obesity may be an important factor to consider during the physical therapy treatment. In particular, combined treatment strategies combining weight management, cardiovascular fitness, and low back pain rehabilitation should be investigated.

Prediction of Cardiorespiratory Fitness by the Six-Minute Step Test and Its Association with Muscle Strength and Power in Sedentary Obese and Lean Young Women: A Cross-Sectional Study

Impaired cardiorespiratory fitness (CRF) is a hallmark characteristic in obese and lean sedentary young women. Peak oxygen consumption (VO_2peak) prediction from the six-minute step test (6MST) has not been established for sedentary females. It is recognized that lower-limb muscle strength and power play a key role during functional activities. The aim of this study was to investigate cardiorespiratory responses during the 6MST and CPX and to develop a predictive equation to estimate VO_2peak in both lean and obese subjects. Additionally we aim to investigate how muscle function impacts functional performance. Lean (LN = 13) and obese (OB = 18) women, aged 20–45, underwent a CPX, two 6MSTs, and isokinetic and isometric knee extensor strength and power evaluations. Regression analysis assessed the ability to predict VO_2peak from the 6MST, age and body mass index (BMI). CPX and 6MST main outcomes were compared between LN and OB and correlated with strength and power variables. CRF, functional capacity, and muscle strength and power were lower in the OB compared to LN (<0.05). During the 6MST, LN and OB reached ~90% of predicted maximal heart rate and ~80% of the VO_2peak obtained during CPX. BMI, age and number of step cycles (NSC) explained 83% of the total variance in VO_2peak. Moderate to strong correlations between VO_2peak at CPX and VO_2peak at 6MST (r = 0.86), VO_2peak at CPX and NSC (r = 0.80), as well as between VO_2peak, NSC and muscle strength and power variables were found (p<0.05). These findings indicate the 6MST, BMI and age accurately predict VO_2peak in both lean and obese young sedentary women. Muscle strength and power were related to measures of aerobic and functional performance.

Obesity among health service providers in Nigeria: danger to long term health worker retention?

INTRODUCTION

Obesity is a global epidemic. There are rising rates of obesity and its associated disorders, especially in developing countries, including among Health Service Providers (HSPs). Obesity is associated with early retirement, increased morbidity and mortality. Thus, obesity has the potential of reducing long-term retention of HSPs in inadequately staffed health systems of developing countries. This study aimed to determine the magnitude of and factors associated with obesity among HSPs of a tertiary health care facility in Lagos, Nigeria.

METHODS

A cross sectional study was carried out with a questionnaire, which included the International Physical Activity Questionnaire short form (IPAQ-SF). Obesity was defined as BMI ≥30kg/m2. Statistical significance was set at p < 0.05.

RESULTS

300 HSPs were recruited, of which 47.7% were medical doctors and dentists, 43.3% were nurses and other categories of HSPs. The mean age and BMI of the HSPs were 39.3(9.0) years and 27.7(4.6) kg/m2 respectively. Eight two (27.3%) HSPs were obese and 134 (44.7%) were overweight, 149(49.7%) had central obesity. After adjusting for confounding variables using multivariate logistic regression, age > 40 years (OR 3.51, p=0.003), female gender (OR 2.84, p=0.007) and earning a monthly salary of ≤ 200,000 naira relative to 201,000-400,000 naira (OR 2.58, p=0.006) were significantly associated with obesity.

CONCLUSION

Obesity was prevalent among these Nigerian HSPs. This calls for concern, especially with the implication of loosing health workers to obesity related disorders and early retirement.

An ICF-Based Model for Implementing and Standardizing Multidisciplinary Obesity Rehabilitation Programs within the Healthcare System

Introduction/Objective: In this study, we aimed to design an ICF-based individual rehabilitation project for obese patients with comorbidities (IRPOb) integrated into the Rehab-CYCLE to standardize rehabilitative programs. This might facilitate the different health professionals involved in the continuum of care of obese patients to standardize rehabilitation interventions. Methods: After training on the ICF and based on the relevant studies, ICF categories were identified in a formal consensus process by our multidisciplinary team. Thereafter, we defined an individual rehabilitation project based on a structured multi-disciplinary approach to obesity. Results: the proposed IRPOb model identified the specific intervention areas (nutritional, physiotherapy, psychology, nursing), the short-term goals, the intervention modalities, the professionals involved and the assessment of the outcomes. Information was shared with the patient who signed informed consent. Conclusions: The model proposed provides the following advantages: (1) standardizes rehabilitative procedures; (2) facilitates the flow of congruent and updated information from the hospital to outpatient facilities, relatives, and care givers; (3) addresses organizational issues; (4) might serve as a benchmark for professionals who have limited specific expertise in rehabilitation of comorbid obese patients.

Body weight status and onset of functional limitations in U.S. middle-aged and older adults

BACKGROUND

The sweeping obesity epidemic could further increase the incidence of functional limitations in the U.S. rapidly aging population.

OBJECTIVE

To examine the relationship between body weight status and onset of functional limitations in U.S. middle-aged and older adults.

METHODS

Study sample came from 1992 to 2010 waves of the Health and Retirement Study, a nationally representative longitudinal survey of community-dwelling middle-aged and older adults. Body mass index (BMI) was calculated from self-reported height/weight. Functional limitations were classified into physical mobility limitation (PM), large muscle function limitation (LMF), activities of daily living limitation (ADL), gross motor function limitation (GMF), and fine motor function limitation (FMF). Mixed-effect logistic regressions were performed to estimate the relationship between prior-wave body weight status and current-wave onset of functional limitations, adjusted for individual characteristics and survey design.

RESULTS

Prior-wave body weight status prospectively predicted onset of functional limitation, and the relationship showed a U-shaped pattern. Compared with their normal weight counterparts, the odds ratios (ORs) in underweight (BMI < 18.5) and obese (BMI ≥ 30) adults were 1.30 (95% confidence interval, 1.05-1.62) and 2.31 (2.11-2.52) for PM, 1.20 (0.96-1.50) and 1.63 (1.49-1.79) for LMF, 2.02 (1.66-2.46) and 1.40 (1.28-1.54) for ADL, 1.96 (1.60-2.39) and 1.77 (1.62-1.93) for GMF, and 1.66 (1.37-2.02) and 1.34 (1.22-1.46) for FMF, respectively. For PM, LMF and GMF, the impact of obesity appeared more pronounced in women, whereas that of underweight more pronounced in men.

CONCLUSIONS

Proper weight management during aging is crucial in preventing functional limitations in middle-aged and older adults.

Sensory integration and response to balance perturbation in overweight physically active individuals

The purpose of this study was to compare sensory integration and response to balance perturbation between physically active normal weight and overweight adults. Physically active young adults were grouped into normal weight (n = 45) or overweight (n = 17) according to the World Health Organization body mass index classification for Asian adults. Participants underwent two balance tests: sensory organization and motor control. Overweight participants presented marginally lower somatosensory score compared to normal weight participants. However, they scored significantly higher in response to balance perturbation. There was no difference in the onset of participants' active response to balance perturbation. Physical activity might have contributed to improved muscle strength and improved the ability of overweight individuals to maintain balance.

Obesity as a Possible Risk Factor for Lost-time Injury in Registered Nurses: A Literature Review

Time-loss injuries are still a major occurrence in Canada, injuring thousands of Canadian workers each year. With obesity rates on the rise across the country, as well as around the world, it is important that the possible effects of obesity in the workplace be fully understood, especially those effects linked to lost-time injuries. The aim of this paper was to evaluate predictors of workplace lost-time injuries and how they may be related to obesity or high body mass index by examining factors associated with lost-time injuries in the health care sector, a well-studied industry with the highest number of reported time loss injuries in Canada. A literature review focusing on lost-time injuries in Registered Nurses (RNs) was conducted using the keywords and terms: lost time injury, workers' compensation, occupational injury, workplace injury, injury, injuries, work, workplace, occupational, nurse, registered nurse, RN, health care, predictors, risk factors, risk, risks, cause, causes, obese, obesity, and body mass index. Data on predictors or factors associated with lost-time injuries in RNs were gathered and organized using Loisel's Work Disability Prevention Management Model and extrapolated upon using existing literature surrounding obesity in the Canadian workplace.

Obesity and outpatient rehabilitation using mobile technologies: the potential mHealth approach

Obesity is currently an important public health problem of epidemic proportions (globesity). Inpatient rehabilitation interventions that aim at improving weight-loss, reducing obesity-related complications and changing dysfunctional behaviors, should ideally be carried out in a multidisciplinary context with a clinical team composed of psychologists, dieticians, psychiatrists, endocrinologists, nutritionists, physiotherapists, etc. Long-term outpatient multidisciplinary treatments are likely to constitute an essential aspect of rehabilitation. Internet-based technologies can improve long-term obesity rehabilitation within a collaborative approach by enhancing the steps specified by psychological and medical treatment protocols. These outcomes may be augmented further by the mHealth approach, through creating new treatment delivery methods to increase compliance and engagement. mHealth (m-health, mobile health) can be defined as the practice of medicine and public health, supported by mobile communication devices for health services and information. mHealth applications which can be implemented in weight loss protocols and obesity rehabilitation are discussed, taking into account future research directions in this promising area.

Physical performance and disability in schizophrenia

Despite 50 years of pharmacological and psychosocial interventions, schizophrenia remains one of the leading causes of disability. Schizophrenia is also a life-shortening illness, caused mainly by poor physical health and its complications. The end result is a considerably reduced lifespan that is marred by reduced levels of independence, with few novel treatment options available.

Disability is a multidimensional construct that results from different, and often interacting, factors associated with specific types and levels of impairment. In schizophrenia, the most poignant and well characterized determinants of disability are symptoms, cognitive and related skills deficits, but there is limited understanding of other relevant factors that contribute to disability. Here we conceptualize how reduced physical performance interacts with aging, neurobiological, treatment-emergent, and cognitive and skills deficits to exacerbate ADL disability and worsen physical health. We argue that clearly defined physical performance components represent underappreciated variables that, as in mentally healthy people, offer accessible targets for exercise interventions to improve ADLs in schizophrenia, alone or in combination with improvements in cognition and health. And, finally, due to the accelerated aging pattern inherent in this disease – lifespans are reduced by 25 years on average – we present a training model based on proven training interventions successfully used in older persons. This model is designed to target the physical and psychological declines associated with decreased independence, coupled with the cardiovascular risk factors and components of the metabolic syndrome seen in schizophrenia due to their excess prevalence of obesity and low fitness levels.

Body mass index gain between ages 20 and 40 years and lifestyle characteristics of men at ages 40-60 years: the Adventist Health Study-2

BACKGROUND

Obesity increases risk of premature disease, and may be associated with unfavorable lifestyle changes that add to risk. This study analyzed the association of midlife BMI change with current lifestyle patterns among multiethnic men.

METHODS

Men aged 40-60 years (n=9864) retrospectively reported body weight between ages 20-40 years and current dietary, TV, physical activity and sleep practices in the Adventist Health Study II, a study of church-goers in the US and Canada. In multivariate logistic regression analysis, odds ratios for BMI gain were calculated for each lifestyle practice controlling for sociodemographic and other lifestyle factors and current BMI.

RESULTS

Men with median or higher BMI gain (2.79 kg/m(2)) between ages 20-40 years were more likely to consume a non-vegetarian diet, and engage in excessive TV watching and little physical activity and had a shorter sleep duration compared to men with BMI gain below the median (all p<0.001). In multivariate logistic analysis current BMI was significantly associated with all lifestyle factors (all p≤0.005). BMI gain was associated with lower odds of vegetarian diet (odds ratio [OR] 0.939; 95% confidence interval [CI] 0.921-0.957) and of physical activity ≥150 min/week (OR 0.979, 95% CI 0.960-0.999).

CONCLUSIONS

These findings imply that diet and less physical activity are associated with both gained and attained BMI, while inactivity (TV watching) and short sleep duration correlated only with attained BMI. Unhealthy lifestyle may add risk to that associated with BMI. Longitudinal and intervention studies are needed to infer causal relationships.