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Shultz SP, Kung SM, Atack AC, Buck AN, Mahaffey R. The impact of pediatric obesity on biomechanical differences across the gait cycle at three walking speeds. Clin Biomech (Bristol, Avon) 2024; 114:106236. [PMID: 38564981 DOI: 10.1016/j.clinbiomech.2024.106236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Revised: 12/23/2023] [Accepted: 03/28/2024] [Indexed: 04/04/2024]
Abstract
BACKGROUND Obesity impacts a child's ability to walk with resulting biomechanical adaptations; however, existing research has not comprehensively compared differences across the gait cycle. We examined differences in lower extremity biomechanics across the gait cycle between children with and without obesity at three walking speeds. METHODS Full gait cycles of age-matched children with obesity (N = 10; BMI: 25.7 ± 4.2 kg/m2) and without obesity (N = 10; BMI: 17.0 ± 1.9 kg/m2) were analyzed at slow, normal, and fast walking speeds. Main and interaction effects of group and speed across hip, knee, and ankle joint angles and moments in sagittal, frontal, and transverse planes were analyzed using one-dimensional statistical parametric mapping. FINDINGS Compared to children without obesity, children with obesity had greater hip adduction during mid-stance, while also producing greater hip extensor moments during early stance phase, abductor moments throughout most of stance, and hip external rotator moments during late stance. Children with obesity recorded greater knee flexor, knee extensor and knee internal rotator moments during early stance, and knee external rotator moments in late stance than children without obesity; children with obesity also demonstrated greater ankle plantarflexor moments throughout mid and late stance. Interaction effects existed within joint kinetics data; children with obesity produced greater hip extensor moments at initial contact and toe-off when walking at fast compared to normal walking speed. INTERPRETATION While few kinematic differences existed between the two groups, children with obesity exhibited greater moments at the hip, knee, and ankle during critical periods of controlling and stabilizing mass.
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Affiliation(s)
- S P Shultz
- School of Sport, Exercise, and Nutrition, Massey University, Wellington, New Zealand; Kinesiology Department, Seattle University, Seattle, Washington, United States; School of Arts and Sciences, Fort Lewis College, Durango, CO, United States.
| | - S M Kung
- School of Sport, Exercise, and Nutrition, Massey University, Wellington, New Zealand; Sports Medicine Department, University of Pittsburgh Medical Center Sports Surgery Clinic, Dublin, Ireland.
| | - A C Atack
- School of Sport, Exercise and Applied Sciences, St Mary's University Twickenham, Twickenham, United Kingdom.
| | - A N Buck
- Kinesiology Department, Seattle University, Seattle, Washington, United States; Department of Exercise and Sport Science, University of North Carolina, Chapel Hill, North Carolina, USA.
| | - R Mahaffey
- School of Sport, Exercise and Applied Sciences, St Mary's University Twickenham, Twickenham, United Kingdom.
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2
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Wolan-Nieroda A, Wojnarska A, Mańko G, Kiper A, Guzik A, Maciejczak A. Assessment of rehabilitation effects in children with mild intellectual disability. Sci Rep 2023; 13:15541. [PMID: 37730865 PMCID: PMC10511505 DOI: 10.1038/s41598-023-42280-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 09/07/2023] [Indexed: 09/22/2023] Open
Abstract
Research on effectiveness of rehabilitation programmes continues to investigate impact of therapeutic interventions on various motor parameters in children with intellectual disability (ID). This study compared the effectiveness of rehabilitation, reflected by physical fitness, static balance, and dynamic balance measurements, in children with mild ID. A total of 70 children with mild ID were enrolled for the study and were divided into two equal groups based on their body mass index (BMI) percentile, reflecting obesity or normal weight. Physical fitness was assessed using the Eurofit Special Test, whereas balance was evaluated with single-leg stance and timed up and go tests. The examinations were performed twice: At the beginning and at the end of a six-month therapy programme. Improvements were shown in the muscle strength of the upper limbs (p < 0.001) and lower limbs (p = 0.001), flexibility (p = 0.005), and static balance (p < 0.001) for the entire cohort. The effects of rehabilitation did not differ significantly between the children with obesity and those with a normal weight. These results may be important from the viewpoint of clinical practice and preventive measures, as they present evidence showing that rehabilitation is equally effective in both obese and normal weight children with mild ID. Therefore, these findings may be of assistance to those designing therapeutic programmes in special education centres.
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Affiliation(s)
- Andżelina Wolan-Nieroda
- Department of Physiotherapy, College of Medical Sciences, Institute of Health Sciences, University of Rzeszów, Rzeszów, Poland
| | - Anna Wojnarska
- Students Scientific Club for Physiotherapy in Adults' and Children's Neurology, Medical College of the University of Rzeszów, Rzeszów, Poland
| | - Grzegorz Mańko
- Department of Biomechanics and Kinesiology, Institute of Physiotherapy, Jagiellonian University Collegium Medicum, Krakow, Poland
- ORNR "Krzeszowice", Rehabilitation Center, Krzeszowice, Poland
| | | | - Agnieszka Guzik
- Department of Physiotherapy, College of Medical Sciences, Institute of Health Sciences, University of Rzeszów, Rzeszów, Poland.
| | - Andrzej Maciejczak
- Institute of Medical Sciences, College of Medical Sciences, University of Rzeszów, Rzeszów, Poland
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Brady K, Kiernan D. The effects of weight gain over time on gait in children with cerebral palsy: Comparison to a matched healthy weight cerebral palsy control group. Obes Res Clin Pract 2023:S1871-403X(23)00024-8. [PMID: 37019723 DOI: 10.1016/j.orcp.2023.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 03/23/2023] [Accepted: 03/30/2023] [Indexed: 04/05/2023]
Abstract
BACKGROUND Children with cerebral palsy (CP) have demonstrated higher rates of overweight and obesity than their typically developed peers. Limited studies have assessed how being overweight or obese affect lower limb kinematics during gait in these children. RESEARCH QUESTION How are lower limb kinematics during gait affected in children with CP who progress from a healthy weight to being overweight or obese compared to a well-matched healthy weight CP control group? METHODS A retrospective analysis of the movement analysis laboratory database was conducted.Children with CP were included if they were aged between 4 and 17 years at baseline,had a follow-up assessment with a minimum of 12 months between assessments, and had no orthopaedic interventions between assessments. A matched control group of children with CP with the same inclusion criteria, except for a requirement of healthy BMI at follow-up, was included. Temporal-spatial and full 3-dimensional lower limb kinematic data were examined. RESULTS Normalized speed and step length reduced from baseline to follow-up for both groups,with no difference in the amount of change between groups. Children with increased BMI demonstrated increased external hip rotation during stance at follow-up not evident in the control group. SIGNIFICANCE Results demonstrated similar changes over time between groups. Increased external hip rotation in children with increased BMI was considered small and within the threshold of error associated with transverse plane kinematics. Our results suggest that being overweight or obese does not result in a meaningful change in lower limb kinematics in children with CP.
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Cao Z, Wu Y, Li Q, Li Y, Wu J. A causal relationship between childhood obesity and risk of osteoarthritis: results from a two-sample Mendelian randomization analysis. Ann Med 2022; 54:1636-1645. [PMID: 35703935 PMCID: PMC9225762 DOI: 10.1080/07853890.2022.2085883] [Citation(s) in RCA: 37] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
PURPOSE It has been found that childhood obesity (CO) may play an important role in the onset and progression of osteoarthritis (OA). Thus we conducted this mendelian randomisation analysis (MR) to evaluate the causal association between childhood obesity and osteoarthritis. METHODS Instrumental variables (IVs) were obtained from publicly available genome-wide association study datasets. The leave-one-out sensitivity test, MR Pleiotropy RESidual Sum and Outlier test (MR-PRESSO), and Cochran's Q test were used to confirm the heterogeneity and pleiotropy of identified IVs, then five different models, including the inverse variance weighted model (IVW), weighted median estimator model (WME), weighted model-based method (WM), MR-Egger regression model (MER), and MR-Robust Adjusted Profile Score (MRAPS) were applied in this MR analysis. RESULTS After excluding all outliers identified by the MR-PRESSO test, no evident directional pleiotropy was found. Significant heterogeneity was found in the secondary MR and as a result, the multiplicative random-effect model was used. Significant causal association between CO and OA (OR 1.0075, 95% CI [1.0054, 1.0010], p = 8.12 × 10-13). The secondary MR also revealed that CO was causally associated with knee OA (OR 1.1067, 95% CI [1.0769, 1.1373], p = 3.30 × 10-13) and hip OA (OR 1.1272, 95% CI [1.0610, 1.1976], p = 1.07 × 10-4). The accuracy and robustness of these findings were confirmed by sensitivity tests. CONCLUSION There appears to be a causal relationship between childhood obesity and OA. Our results indicate that individuals with a history of childhood obesity require specific clinical attention to prevent the development of knee and hip OA.
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Affiliation(s)
- Ziqin Cao
- Department of Spine Surgery and Orthopaedics, Xiangya Hospital, Central South University, Changsha, China
| | - Yudi Wu
- Nanchang University Queen Mary School, Nanchang, China
| | - Qiangxiang Li
- Ningxia Geriatric Disease Clinical Research Center, People's Hospital of Ningxia Hui Autonomous Region, Yinchuan, China.,National Clinical Research Center for Geriatric Disorders of Xiangya hospital, Central South University (Sub-center of Ningxia), Yinchuan, China.,Department of Hunan Institute of Geriatrics, Hunan People's Hospital, Changsha, China
| | - Yajia Li
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, China.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Jianhuang Wu
- Department of Spine Surgery and Orthopaedics, Xiangya Hospital, Central South University, Changsha, China.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
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5
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Spech C, Paponetti M, Mansfield C, Schmitt L, Briggs M. Biomechanical variations in children who are overweight and obese during high-impact activities: A systematic review and meta-analysis. Obes Rev 2022; 23:e13431. [PMID: 35112792 DOI: 10.1111/obr.13431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 01/07/2022] [Accepted: 01/09/2022] [Indexed: 11/29/2022]
Abstract
Youth who are obese or overweight demonstrate evidence of poor lower extremity joint health and alterations in gait characteristics compared with youth who are healthy weight. However, there is no consensus if altered movement patterns are still present during high-impact activities. The purpose of this review was to determine if spatiotemporal and kinematic and kinetic variables during high-impact activities were significantly different between youth who are overweight and obese compared with youth who are healthy weight. An electronic search of five databases was conducted, and a meta-analysis and qualitative evidence synthesis was performed to determine the level of evidence, analyzing three tasks: running, jumping, and hopping. The findings of this review include the following: (1) overweight/obese (OW/OB) had higher stance phase time during running, (2) OW/OB had decreased hip flexion angles during running and stationary running, (3) OW/OB had decreased knee flexion angles during landing phase of jumping and hopping, and (4) OW/OB had increased hip abduction moments during running and jumping. These altered kinematic and kinetic variables at the hip and knee may result in mechanical inefficiency with high-impact activities, as well as potentially increased risk of joint degradation and poor joint health into adulthood.
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Affiliation(s)
- Claire Spech
- Division of Physical Therapy, School of Health and Rehabilitation Sciences, College of Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Matthew Paponetti
- Division of Physical Therapy, School of Health and Rehabilitation Sciences, College of Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Cody Mansfield
- Health and Rehabilitation Sciences PhD Program, School of Health and Rehabilitation Sciences, College of Medicine, The Ohio State University, Columbus, Ohio, USA.,OSU Sports Medicine, Jameson Crane Sports Medicine Institute, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Laura Schmitt
- Division of Physical Therapy, School of Health and Rehabilitation Sciences, College of Medicine, The Ohio State University, Columbus, Ohio, USA.,OSU Sports Medicine, Jameson Crane Sports Medicine Institute, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Matthew Briggs
- Division of Physical Therapy, School of Health and Rehabilitation Sciences, College of Medicine, The Ohio State University, Columbus, Ohio, USA.,OSU Sports Medicine, Jameson Crane Sports Medicine Institute, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
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Rogers DL, Klyce W, Kajstura TJ, Lee RJ. Association of Body Mass Index With Severity and Lesion Location in Adolescents With Osteochondritis Dissecans of the Knee. Orthop J Sports Med 2022; 9:23259671211045382. [PMID: 35146035 PMCID: PMC8822100 DOI: 10.1177/23259671211045382] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 06/23/2021] [Indexed: 12/26/2022] Open
Abstract
Background: The association between body mass index (BMI) and severity of osteochondritis dissecans (OCD) of the knee at presentation is poorly understood. Hypothesis: We hypothesized that adolescents in higher BMI percentiles for age and sex would have OCD lesions that were more severe at their initial presentation and located more posteriorly on the condyle as compared with adolescents in lower BMI percentiles. Study Design: Cohort study; Level of evidence, 3. Methods: This study included patients aged 10 to 18 years who were treated for knee OCD at a tertiary care hospital from 2006 to 2017. Patients with noncondylar OCD or missing BMI data within 3 months of presentation were excluded. Patients were stratified per the Centers for Disease Control and Prevention guidelines as underweight, normal weight, overweight, or obese, and the groups were compared according to age, side of lesion, 4 markers of lesion severity (cystic changes, loose fragments, subchondral fluid, and subchondral edema), and surgical treatment. Lesion angle was measured in reference to a line parallel to the femoral axis drawn through the center of a best-fit circle covering the distal condyle. Data were analyzed using chi-square tests, relative risk, Student t tests, analysis of variance, and linear regression of cumulative running percentages. Bonferroni correction was performed when applicable. Results: A total of 77 patients met our inclusion criteria (mean age, 14.2 years; range, 10.1-18.8): 2 were underweight, 50 had normal BMI, 13 were overweight, and 12 were obese. We found correlations between BMI percentile and surgical treatment (R2 = .732), subchondral fluid (R2 = .716), subchondral edema (R2 = .63), loose fragments (R2 = .835), and the presence of at least 1 marker of lesion severity (R2 = .857) (P < .0001 for all). No correlation was observed for cystic changes (R2 = .026). There were significant associations between BMI ≥80th percentile and subchondral edema (risk ratio, 2.5; 95% CI, 1.3-4.8), medial condylar lesions (risk ratio, 1.3; 95% CI, 1.01-1.7), and lesions more anterior on the condyle (P < .05). Conclusion: Higher BMI in adolescents was strongly correlated with multiple markers of severity of knee OCD at initial presentation as well as with more anterior lesions.
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Affiliation(s)
- Davis L. Rogers
- Pediatric Division, Department of Orthopaedics, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Walter Klyce
- Pediatric Division, Department of Orthopaedics, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Tymoteusz J. Kajstura
- Pediatric Division, Department of Orthopaedics, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - R. Jay Lee
- Pediatric Division, Department of Orthopaedics, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- R. Jay Lee, MD, Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, 1800 Orleans St, Baltimore, MD 21287, USA ()
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Capodaglio P, Gobbi M, Donno L, Fumagalli A, Buratto C, Galli M, Cimolin V. Effect of Obesity on Knee and Ankle Biomechanics during Walking. SENSORS 2021; 21:s21217114. [PMID: 34770421 PMCID: PMC8588043 DOI: 10.3390/s21217114] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 10/20/2021] [Accepted: 10/22/2021] [Indexed: 11/30/2022]
Abstract
The purpose of this retrospective study was to quantify the three-dimensional knee and ankle joint kinematics and kinetics during walking in young participants with different degrees of obesity and to identify the associated effects by stratifying the obese participants according to their BMI. Thirty-two young obese individuals (mean age 30.32 years) and 16 normal-weight age-matched individuals were tested using 3D gait analysis. Analysis of kinematic and kinetic data revealed significant differences in mechanics at knee and ankle joints in all the evaluated planes of movement. Compared to the healthy-weight participants, obese adults demonstrated less knee flexion, greater knee ab-adduction angle during the entire gait cycle and abnormalities at the knee flex-extension moment. At the ankle joint, reduced range of motion was observed together with a lower peak of ankle plantarflexor moment and power during terminal stance. These results provide insight into a potential pathway by which obesity predisposes a healthy adult for increased risk of osteoarthritis.
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Affiliation(s)
- Paolo Capodaglio
- Orthopaedic Rehabilitation Unit and Clinical Lab for Gait Analysis and Posture, Ospedale San Giuseppe, Istituto Auxologico Italiano, IRCCS, Via Cadorna 90, 28824 Verbania, Italy; (M.G.); (A.F.)
- Department of Surgical Sciences, Physical and Rehabilitation Medicine, University of Torino, Via Giuseppe Verdi, 8, 10124 Torino, Italy
- Correspondence:
| | - Michele Gobbi
- Orthopaedic Rehabilitation Unit and Clinical Lab for Gait Analysis and Posture, Ospedale San Giuseppe, Istituto Auxologico Italiano, IRCCS, Via Cadorna 90, 28824 Verbania, Italy; (M.G.); (A.F.)
| | - Lucia Donno
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Piazza Leonardo da Vinci 32, 20133 Milano, Italy; (L.D.); (M.G.); (V.C.)
| | - Andrea Fumagalli
- Orthopaedic Rehabilitation Unit and Clinical Lab for Gait Analysis and Posture, Ospedale San Giuseppe, Istituto Auxologico Italiano, IRCCS, Via Cadorna 90, 28824 Verbania, Italy; (M.G.); (A.F.)
| | - Camillo Buratto
- Podartis srl, Via Erizzo 123/c, 31035 Crocetta del Montello, Italy;
| | - Manuela Galli
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Piazza Leonardo da Vinci 32, 20133 Milano, Italy; (L.D.); (M.G.); (V.C.)
| | - Veronica Cimolin
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Piazza Leonardo da Vinci 32, 20133 Milano, Italy; (L.D.); (M.G.); (V.C.)
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Pau M, Capodaglio P, Leban B, Porta M, Galli M, Cimolin V. Kinematics Adaptation and Inter-Limb Symmetry during Gait in Obese Adults. SENSORS (BASEL, SWITZERLAND) 2021; 21:5980. [PMID: 34502875 PMCID: PMC8434679 DOI: 10.3390/s21175980] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 08/23/2021] [Accepted: 09/01/2021] [Indexed: 11/16/2022]
Abstract
The main purpose of this study is to characterize lower limb joint kinematics during gait in obese individuals by analyzing inter-limb symmetry and angular trends of lower limb joints during walking. To this purpose, 26 obese individuals (mean age 28.5 years) and 26 normal-weight age- and sex-matched were tested using 3D gait analysis. Raw kinematic data were processed to derive joint-specific angle trends and angle-angle diagrams (synchronized cyclograms) which were characterized in terms of area, orientation and trend symmetry parameters. The results show that obese individuals exhibit a kinematic pattern which significantly differs from those of normal weight especially in the stance phase. In terms of inter-limb symmetry, higher values were found in obese individuals for all the considered parameters, even though the statistical significance was detected only in the case of trend symmetry index at ankle joint. The described alterations of gait kinematics in the obese individuals and especially the results on gait asymmetry are important, because the cyclic uneven movement repeated for hours daily can involve asymmetrical spine loading and cause lumbar pain and could be dangerous for overweight individuals.
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Affiliation(s)
- Massimiliano Pau
- Department of Mechanical, Chemical and Materials Engineering, University of Cagliari, 09123 Cagliari, Italy; (M.P.); (B.L.); (M.P.)
| | - Paolo Capodaglio
- Orthopaedic Rehabilitation Unit and Clinical Lab for Gait Analysis and Posture, Istituto Auxologico Italiano IRCCS, San Giuseppe Hospital, 28824 Verbania, Italy;
- Department Surgical Sciences, Physical and Rehabilitation Medicine, University of Turin, 10124 Turin, Italy
| | - Bruno Leban
- Department of Mechanical, Chemical and Materials Engineering, University of Cagliari, 09123 Cagliari, Italy; (M.P.); (B.L.); (M.P.)
| | - Micaela Porta
- Department of Mechanical, Chemical and Materials Engineering, University of Cagliari, 09123 Cagliari, Italy; (M.P.); (B.L.); (M.P.)
| | - Manuela Galli
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Piazza Leonardo da Vinci 32, 20133 Milano, Italy;
| | - Veronica Cimolin
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Piazza Leonardo da Vinci 32, 20133 Milano, Italy;
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Bowser BJ, Roles K. Effects of Overweight and Obesity on Running Mechanics in Children. Med Sci Sports Exerc 2021; 53:2101-2110. [PMID: 33867501 DOI: 10.1249/mss.0000000000002686] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
PURPOSE The purpose of this study is to determine differences in running mechanics between healthy weight (HW) children and children classified as OW/OB. METHODS Forty-two children (17 OW/OB, 25 HW) ran overground while kinematic and kinetic data were recorded using a motion capture system and force plate. Kinematic variables of interest included stance time, step length, and frontal and sagittal plane joint angles and excursions at the hip, knee, and ankle. Kinetic variables of interest included ground reaction forces and hip, knee, and ankle moments in the sagittal and frontal planes. RESULTS The OW/OB group spent more time in stance, took shorter steps, displayed less hip flexion during the first half of stance, had greater ankle inversion at foot strike, had greater knee abduction throughout stance, and had smaller knee flexion, knee adduction, and hip adduction excursions. In comparing unscaled ground reaction forces, the OW/OB group displayed greater peak vertical force, vertical impact peaks, and vertical loading rates. The OW/OB group also displayed greater unscaled plantar and dorsiflexion moments, knee flexion and extension moments, ankle inversion moments, and knee and hip abduction moments. CONCLUSION These data suggest that increased body weight in children is associated with changes in running mechanics. Higher joint moments and ground reaction forces may indicate increased injury risk or the development of joint degeneration among overweight/obese children.
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Affiliation(s)
- Bradley J Bowser
- Department of Health and Nutritional Sciences, South Dakota State University, Brookings, SD
| | - Kristen Roles
- Department of Anesthesiology, Washington University School of Medicine in St. Louis, St. Louis, MO
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Singh B, Takeda MM, Niino MF, Goulart JD, Hammons AJ, Roos JM, Yack HJ. The effects of adiposity, muscular strength, cardiorespiratory fitness, and fatigue on gait biomechanics in overweight and obese children. Clin Biomech (Bristol, Avon) 2021; 84:105332. [PMID: 33819825 DOI: 10.1016/j.clinbiomech.2021.105332] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 03/10/2021] [Accepted: 03/19/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Obesity rates continue to increase in the child population. Muscular strength, cardiorespiratory fitness, and fatigue can potentially affect joint stresses in obese children. The purposes are to examine: (1) the relationship between cardiorespiratory fitness and the change in joint stress pre- to post-fatigue; (2) the predictive value of fitness, adiposity, and muscular strength on joint stresses in fatigued and non-fatigued states; and, (3) the relationships between % body fat from skinfold and air displacement plethysmography. METHODS Twenty-seven children, with body mass index above the 85th percentile for their age participated in this study. Lower limb joint moments were recorded before and after a fatiguing Progressive Aerobic Cardiovascular Endurance Run protocol. Linear regression was used to assess the relationship between (1) fitness and change in joint stress pre- to post-fatigue, and (2) measures of %body fat using skinfold and plethysmography. Furthermore, Bland-Altman analysis quantified the agreement between measured adiposity using the two methods. FINDINGS The strongest relationship was observed between fitness and the change in the knee extensor moment pre- to post-fatigue (R2 = 0.24). Regardless of fatigue state, adiposity and strength were identified as the strongest predictors of joint moments. Skinfold estimates were moderately predictive (R2 = 0.56) of %body fat from air displacement plethysmography, and these two measures demonstrated instrument agreement with no proportional bias. INTERPRETATION Fitness level is not related to changes in biomechanics pre- to post-fatigue in overweight and obese children. Adiposity and lower extremity strength most strongly influenced joint moments in the frontal and sagittal planes.
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Affiliation(s)
- Bhupinder Singh
- Department of Physical Therapy, Manchester University, 10627 Diebold Rd., Fort Wayne, IN 46845-4463, United States; Department of Physical Therapy at College of Health and Human Sciences, California State University, Fresno. 5315 N. Campus Dr., M/S PT29, Fresno, CA 93740-8019, United States.
| | - Mami M Takeda
- Department of Physical Therapy at College of Health and Human Sciences, California State University, Fresno. 5315 N. Campus Dr., M/S PT29, Fresno, CA 93740-8019, United States
| | - Melanie F Niino
- Department of Physical Therapy at College of Health and Human Sciences, California State University, Fresno. 5315 N. Campus Dr., M/S PT29, Fresno, CA 93740-8019, United States
| | - Jennifer D Goulart
- Department of Physical Therapy at College of Health and Human Sciences, California State University, Fresno. 5315 N. Campus Dr., M/S PT29, Fresno, CA 93740-8019, United States
| | - Amber J Hammons
- Child and Family Science, California State University, Fresno. 5300N. Campus Dr., M/S FF12, Fresno, CA 93720, United States
| | - Jennifer M Roos
- Department of Physical Therapy at College of Health and Human Sciences, California State University, Fresno. 5315 N. Campus Dr., M/S PT29, Fresno, CA 93740-8019, United States
| | - H John Yack
- Department of Physical Therapy and Rehabilitation Science, 100 Medical Education Bldg. Rm 1-252, Iowa City, IA 52242-1190, United States
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11
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Cilli M, Serbest K, Kayaoglu E. The effect of body weight on joint torques in teenagers: Investigation of sit-to-stand movement. Clin Biomech (Bristol, Avon) 2021; 83:105288. [PMID: 33609961 DOI: 10.1016/j.clinbiomech.2021.105288] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Revised: 01/21/2021] [Accepted: 01/27/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Obesity is becoming more common in the world. This causes various health problems, especially musculoskeletal disorders. Previous studies have examined the kinematic effects of increasing weight on joints. However, the mechanical effects of movement patterns have not yet been described. The aim of this study was to investigate joint torques in sit-to-stand movement in teenagers with a range of body mass indices (BMI). METHODS 20 participants (12-17 years old) participated the study. They were divided into 4 groups according to BMI. Participants performed sit-to-stand movements and the video was captured. Angular displacement, angular velocity, and angular acceleration were calculated for each joint. A four-degree-of-freedom link-segment model was created for a dynamic analysis of sit-to-stand. Joint torques were calculated using the inverse dynamic method. FINDINGS Overweight increases joint torques in hips, knees, and ankles. In obese participants with a BMI 36% higher than normal-weight participants, joint torques in hips, knees, and ankles were higher by 46, 48, and 33%, respectively. In underweight participants with a BMI 21% lower than normal-weight participants, joint torques in neck, hip, knee, and ankle were lower by 20, 30, 17, and 7%, respectively. INTERPRETATION Overweight participants have a different sit-to-stand movement pattern. Movement differences and overweight may cause an overload on joints.
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Affiliation(s)
- Murat Cilli
- Sakarya University of Applied Science, Faculty of Sport Science, Department of Coaching Education, Turkey
| | - Kasim Serbest
- Sakarya University of Applied Science, Faculty of Technology, Department of Mechatronics Engineering, Turkey.
| | - Emre Kayaoglu
- Sakarya University of Applied Science, Faculty of Sport Science, Department of Coaching Education, Turkey
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12
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Karuc J, Marković G, Mišigoj-Duraković M, Duncan MJ, Sorić M. Is Adiposity Associated with the Quality of Movement Patterns in the Mid-Adolescent Period? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17249230. [PMID: 33321850 PMCID: PMC7763001 DOI: 10.3390/ijerph17249230] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 12/08/2020] [Accepted: 12/09/2020] [Indexed: 12/18/2022]
Abstract
This study examined the association between functional movement (FM) and adiposity in adolescent population (16–17 years). This study was conducted in a representative sample of urban adolescents as the part of the CRO-PALS longitudinal study (n = 652). Body mass index (BMI), a sum of four skinfolds (S4S), waist and hip circumference were measured, and FM was assessed via Functional Movement ScreenTM (FMSTM). Furthermore, total FMSTM screen was indicator of FM with the composite score ranged from 7 to 21, with higher score indicating better FM. Multilevel analysis was employed to determine the relationship between different predictors and total FMS score. In boys, after controlling for age, moderate-to-vigorous physical activity, and socioeconomic status, total FMS score was inversely associated only with BMI (β = −0.18, p < 0.0001), S4S (β = −0.04, p < 0.0001), waist circumference (β = −0.08, p < 0.0001), and hip circumference (β = −0.09, p < 0.0001). However, among girls, in adjusted models, total FMS score was inversely associated with S4S (β = −0.03, p < 0.0001), while BMI (β = −0.05, p = 0.23), waist circumference (β = −0.04, p = 0.06), and hip circumference: (β = −0.01, p = 0.70) failed to reach statistical significance. Results showed that the association between adiposity and FM in adolescence is sex-specific, suggesting that boys with overweight and obesity could be more prone to develop dysfunctional movement patterns. Therefore, exercise interventions directed toward correcting dysfunctional movement patterns should be sex-specific, targeting more boys with overweight and obesity rather than adolescent girls with excess weight.
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Affiliation(s)
- Josip Karuc
- Faculty of Kinesiology, University of Zagreb, 10000 Zagreb, Croatia; (G.M.); (M.M.-D.); (M.S.)
- Correspondence:
| | - Goran Marković
- Faculty of Kinesiology, University of Zagreb, 10000 Zagreb, Croatia; (G.M.); (M.M.-D.); (M.S.)
| | | | - Michael J. Duncan
- Faculty Research Centre for Sport, Exercise and Life Sciences, Coventry University, Coventry CV1 5FB, UK;
| | - Maroje Sorić
- Faculty of Kinesiology, University of Zagreb, 10000 Zagreb, Croatia; (G.M.); (M.M.-D.); (M.S.)
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13
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Dupont G, Bordes SJ, Lachkar S, Wahl L, Iwanaga J, Loukas M, Tubbs RS. The effects of obesity on the human body, part I: Skin and musculoskeletal. Clin Anat 2020; 34:297-302. [PMID: 32986278 DOI: 10.1002/ca.23683] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 09/11/2020] [Indexed: 11/07/2022]
Abstract
Obesity is a worldwide issue that many global health authorities consider a growing epidemic. Having a positive correlation between increases in the industrialization of processed foods and sedentary occupations as well as a lack of access to healthcare in poorer socioeconomic areas, obesity is a multifactorial disease affecting several organ systems. The tendency for obesity to cause detrimental changes to the human body is a focal point for healthcare providers to establish more effective clinical treatment and management plans. Implementing comprehensive global educational programs to decrease the prevalence of this unforgiving disease is imperative for a healthier future. Herein, we have provided a comprehensive review of the health effects of obesity upon the human body for the interest of many practicing clinicians managing this health crisis.
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Affiliation(s)
- Graham Dupont
- Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Stephen J Bordes
- Department of Anatomical Sciences, St. George's University School of Medicine, St. George's, Grenada
| | | | - Lauren Wahl
- Department of Cell and Developmental Biology, University of Colorado, Boulder, Colorado, USA
| | - Joe Iwanaga
- Division of Gross and Clinical Anatomy, Department of Anatomy, Kurume University School of Medicine, Fukuoka, Japan.,Department of Neurosurgery, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, Louisiana, USA.,Department of Neurology, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Marios Loukas
- Department of Anatomical Sciences, St. George's University School of Medicine, St. George's, Grenada.,Department of Anatomy, University of Warmia and Mazury, Olsztyn, Poland
| | - R Shane Tubbs
- Department of Anatomical Sciences, St. George's University School of Medicine, St. George's, Grenada.,Department of Neurosurgery, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, Louisiana, USA.,Department of Neurology, Tulane University School of Medicine, New Orleans, Louisiana, USA.,Department of Structural and Cellular Biology, Tulane University School of Medicine, New Orleans, Louisiana, USA
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14
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Musikachart P, Eamsobhana P. Do Different Tibial Osteotomy Techniques Affect Sagittal Alignment in Children with Blount Disease? Orthop Surg 2020; 12:770-775. [PMID: 32301285 PMCID: PMC7307263 DOI: 10.1111/os.12674] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 03/17/2020] [Accepted: 03/18/2020] [Indexed: 01/01/2023] Open
Abstract
Objective To determine the radiographic outcomes following dome or wedge‐shaped proximal tibial osteotomy in the management of infantile Blount disease with a particular interest in sagittal alignment of the knee joint. Method Medical records of patients with Langenskiöld stage 2 Blount disease (aged ≤5 years) who underwent surgical correction between January 2005 and November 2019 were retrospectively identified. Patients with metabolic bone disease, bone tumors, prior traumatic fractures, congenital anomalies, inadequate plain films, and incomplete medical documents were excluded. Patient characteristics (e.g. age, gender, and body mass index [BMI]) and surgical characteristics (e.g. side, type of surgery, and follow‐up times) were recorded. Antero–posterior (AP) and lateral knee radiographs were analyzed. Data were categorized by surgical technique as dome‐shaped proximal tibial osteotomy or wedge‐shaped proximal tibial osteotomy. The femorotibial angle (FTA) was used to evaluate the correction angle in varus deformities. Sagittal alignment of the lower limbs using the posterior tibial slope (PTS) angle was measured postoperatively at 3, 6, 12, and 24 months, and at the final follow‐up visit. Results The present study included 72 surgeries of 46 patients who had undergone proximal tibial osteotomy. Twenty‐nine (63%) were male. The mean age of patients at the time of surgery was 34.50 months (range, 26–47). The mean weight was 23.11 ± 4.98 kg (mean ± SD); the mean height was 95.33 ± 6.36 cm, and the mean BMI was 25.32 ± 4.36 kg/m2. The mean duration of follow up was 4.77 ± 2.78 years. Sixty‐four patients (88.90%) received dome‐shaped proximal osteotomy of the tibia, while 8 (11.10%) received wedge‐shaped proximal osteotomy of the tibia. The average FTA of the total correction measured was 29.32° ± 7.98°. The demographic data of the two groups were not significantly different for gender, age, BMI, side follow‐up times, and the total correction of varus deformities. In the dome‐shaped osteotomy group, the mean correction of the FTA was 29.59° ± 7.45°. The mean degree of the PTS angle was 6.50° at 3 months, 6.38° at 6 months, 5.32° at 12 months, 5.17° at 24 months, and 5.53° at the final follow‐up visit. In the wedge‐shaped proximal tibial osteotomy group, the mean correction of the FTA was 27.25° ± 11.77°. The PTS was 6.00° at 3 months, 7.50° at 6 months, 7.00° at 12 months, 5.40° at 24 months, and 5.57° at the final follow‐up visit. No significant difference was observed in the radiological outcome between surgical techniques. Conclusion Dome and wedge‐shaped proximal tibial osteotomies did not demonstrate significant differences in the PTS angle in children with Blount disease.
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Affiliation(s)
- Piyanuch Musikachart
- Department of Biochemistry,Siriraj Hospital, Mahidol University Bangkok Thailand
- Department of Orthopaedic SurgerySiriraj Hospital, Mahidol University Bangkok Thailand
| | - Perajit Eamsobhana
- Department of Biochemistry,Siriraj Hospital, Mahidol University Bangkok Thailand
- Department of Orthopaedic SurgerySiriraj Hospital, Mahidol University Bangkok Thailand
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15
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Chaplais E, Naughton G, Dutheil F, Masurier J, Greene D, Pereira B, Duclos M, Thivel D, Courteix D. Geometric and Mechanical Bone Response to a Multidisciplinary Weight Loss Intervention in Adolescents With Obesity: The ADIBOX Study. J Clin Densitom 2020; 23:254-263. [PMID: 30076009 DOI: 10.1016/j.jocd.2018.06.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Revised: 06/11/2018] [Accepted: 06/11/2018] [Indexed: 01/27/2023]
Abstract
The effectiveness of structured multidisciplinary weight loss (WL) programs combining nutrition and physical activity on bone geometry and strength remains uncertain in adolescents with obesity. The study investigated the impact of a structured WL intervention on bone geometry and strength in adolescents with obesity. Thirty-one adolescents with obesity (mean [standard deviation] 13.61 [1.27] yr, body mass index Z-score 2.26 [0.30]) experienced an 8-mo WL program. A group of 23 maturation-matched controls (mean [standard deviation] 15.90 [0.43] yr, body mass index Z-score -0.12 [0.48]) were recruited for calculating Z-scores. Body composition, bone density, geometry, and mechanical properties were assessed using dual-energy X-ray absorptiometry and dual-energy X-ray absorptiometry-derived hip structural analysis. Plasma concentration of leptin, estradiol, collagen type 1 cross-linked C-telopeptide (CTx), and procollagen type 1 N-terminal propeptide were measured. Longitudinal analysis showed that adolescents with obesity reduced body weight and fat mass (total [g, %; p < 0.007]). After 8 mo, body mineral density at total body less head (Δ 3.22 [3.58] % p < 0.001) and lumbar spine (Δ 3.67 [4.04] % p < 0.001) increased. At the narrow neck (NN) of the femur, lower body mineral density (Δ -7.19 [8.79] % p < 0.001) and higher endocortical diameter and width were observed (NN endocortical diameter Δ 2.85 [0.26] %, NN width Δ 5.48 [10.84] %, respectively). An increased buckling ratio (Δ 8.24 [2.00] % p = 0.005) was also evident. Similar concentration of procollagen type 1 N-terminal propeptide and CTx was seen from baseline to 8 mo. However, at 4 mo, lower CTx levels were observed. The 8-mo WL program was associated with some positive adaptations among bone density parameters for the whole body and spine. However, bone geometry and strength estimates appeared to weaken at the NN. Clinically, the buckling ratio score at the NN was close to the fracture threshold. An "androgynous-like" adaptation was observed with bone geometry changes demonstrating periosteal expansion and endocortical resorption.
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Affiliation(s)
- Elodie Chaplais
- Université Clermont Auvergne, Laboratory of the Metabolic Adaptations to Exercise under Physiological and Pathological Conditions (AME2P), Clermont-Ferrand, France; School of Exercise Science, Australian Catholic University, Strathfield, NSW, Australia; Faculty of Health, Australian Catholic University, Melbourne, VIC, Australia.
| | - Geraldine Naughton
- Faculty of Health, Australian Catholic University, Melbourne, VIC, Australia
| | - Frederic Dutheil
- Faculty of Health, Australian Catholic University, Melbourne, VIC, Australia; Université Clermont Auvergne, CNRS, LaPSCo, Physiological and Psychosocial Stress, CHU Clermont-Ferrand, University Hospital of Clermont-Ferrand, Occupational and Preventive Medicine, WittyFit, Clermont-Ferrand, France
| | | | - David Greene
- School of Exercise Science, Australian Catholic University, Strathfield, NSW, Australia
| | - Bruno Pereira
- CHU Clermont-Ferrand, University Hospital of Clermont-Ferrand, the Clinical Research and Innovation Direction, Clermont-Ferrand, France
| | - Martine Duclos
- Université Clermont Auvergne, INRA, UNH, Unité de Nutrition Humaine, CRNH Auvergne, CHU Clermont-Ferrand, University Hospital of Clermont-Ferrand, Sports Medicine, Clermont-Ferrand, France; CRNH Auvergne, Clermont-Ferrand, France
| | - David Thivel
- Université Clermont Auvergne, Laboratory of the Metabolic Adaptations to Exercise under Physiological and Pathological Conditions (AME2P), Clermont-Ferrand, France; CRNH Auvergne, Clermont-Ferrand, France
| | - Daniel Courteix
- Université Clermont Auvergne, Laboratory of the Metabolic Adaptations to Exercise under Physiological and Pathological Conditions (AME2P), Clermont-Ferrand, France; Faculty of Health, Australian Catholic University, Melbourne, VIC, Australia; CRNH Auvergne, Clermont-Ferrand, France
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16
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Stokes A, Lundberg DJ, Sheridan B, Hempstead K, Morone NE, Lasser KE, Trinquart L, Neogi T. Association of Obesity With Prescription Opioids for Painful Conditions in Patients Seeking Primary Care in the US. JAMA Netw Open 2020; 3:e202012. [PMID: 32239222 PMCID: PMC7118518 DOI: 10.1001/jamanetworkopen.2020.2012] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
IMPORTANCE Prior studies have identified an association between obesity and prescription opioid use in the US. However, the pain conditions that are factors in this association remain unestablished. OBJECTIVE To investigate the association between obesity and pain diagnoses recorded by primary care clinicians as reasons for prescription of opioids. DESIGN, SETTING, AND PARTICIPANTS A cross-sectional study including 565 930 patients aged 35 to 64 years with a body mass index (BMI) measurement recorded in 2016 was conducted. Electronic health records of patients seen by primary care clinicians in the US in the multipayer athenahealth network from January 1, 2015, to December 31, 2017, were reviewed, and data were analyzed from March 1 to September 15, 2019. MAIN OUTCOMES AND MEASURES Any prescription of opioids in the 365 days before or after the first BMI measurement in 2016 were identified. All International Classification of Diseases, Ninth Revision, and International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, claims within 7 days before each opioid prescription were captured and classified using a pain diagnosis typologic system. Weight was categorized as underweight (BMI, 18.5-19.9), normal weight (BMI, 20.0-24.9), overweight (BMI, 25.0-29.9), obese I (BMI, 30-34.9), obese II (BMI, 35.0-39.9), obese III (BMI, 40.0-49.9), and obese IV (BMI, 50.0-80.0). RESULTS Among 565 930 patients, 329 083 (58.1%) were women. A total of 125 093 patients (22.1%) were aged 35 to 44 years, 199 384 patients (35.2%) were 45 to 54 years, and 241 453 patients (42.7%) were 55 to 64 years. A total of 177 631 patients (31.4%) were overweight and 273 135 patients (48.2%) were obese at baseline. Over 2 years, 93 954 patients (16.6%) were prescribed opioids. The risk of receiving prescription opioids increased progressively with BMI (adjusted relative risk for overweight: 1.08; 95% CI, 1.06-1.10; obese I: 1.24; 95% CI, 1.22-1.26; obese II: 1.33; 95% CI, 1.30-1.36; obese III: 1.48; 95% CI, 1.45-1.51; and obese IV, 1.71; 95% CI, 1.65-1.77). The percentage of patients with opioid prescriptions attributable to an overweight or obese BMI was 16.2% (95% CI, 15.0%-17.4%). Prescription opioids for management of osteoarthritis (relative risk for obese vs normal weight, 1.90; 95% CI, 1.77-2.05) and other joint disorders (relative risk, 1.63; 95% CI, 1.55-1.72) both had stronger associations with obesity than the mean for any pain diagnosis (relative risk, 1.33; 95% CI, 1.31-1.36). Osteoarthritis, other joint disorders, and other back disorders comprised a combined 53.4% of the absolute difference in prescription of opioids by obesity. CONCLUSIONS AND RELEVANCE Joint and back disorders appear to be the most important diagnoses in explaining the increased receipt of opioid prescriptions among patients with obesity. Addressing the opioid crisis will require attention to underlying sources of demand for prescription opioids, including obesity, through its associations with pain.
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Affiliation(s)
- Andrew Stokes
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts
| | - Dielle J. Lundberg
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts
| | | | | | - Natalia E. Morone
- Section of General Internal Medicine, Boston University School of Medicine, Boston, Massachusetts
| | - Karen E. Lasser
- Section of General Internal Medicine, Boston University School of Medicine, Boston, Massachusetts
- Department of Community Health Sciences, Boston University School of Public Health, Boston, Massachusetts
| | - Ludovic Trinquart
- Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts
| | - Tuhina Neogi
- Section of Rheumatology, Boston University School of Medicine, Boston, Massachusetts
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts
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17
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Spinoso DH, Carvalho MVDS, Trentin ACDS, Navega MT. Acute effect of partial body weight suspension on the level of cocontraction and gait biomechanics in women with knee osteoarthritis. FISIOTERAPIA EM MOVIMENTO 2020. [DOI: 10.1590/1980-5918.033.ao26] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Abstract Introduction: Knee osteoarthritis (OAK) is one of the most prevalent rheumatic diseases in the population, characterized by functional limitation and gait difficulties with profound clinical relevance, as walking is the most frequently performed daily activity. These functional limitations may be more pronounced when the disease is associated with obesity. Objective: To investigate the effect of different body weight suspension percentages on gait biomechanical variables and co-contraction percentages in women with OAK. Method: Fourteen women aged 50-75 years, with a body mass index between 26 and 35 and radiological diagnosis of OAK participated in the study. On the first day, anamnesis and familiarization with gait on the treadmill was performed. On the second day, treadmill gait assessment was performed using partial body weight support (SPPC) in three conditions-15%, 30%, and 45% suspension. During the evaluation, electromyographic and kinematic data were collected. The variables analyzed were percentage of hip (gluteus maximus/rectus femoris), knee (femoral biceps/vastus lateralis), and ankle (anterior tibial/lateral gastrocnemius), and length and step widths. A one-way analysis of variance was conducted, with a significance level of p < 0.05. Results: There was no significant difference in the length and step width and the level of co-contraction between the running conditions analyzed. Conclusion: Body weight suspension using SPPC during treadmill running did not alter the biomechanical variables of the gait of women with OAK.
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18
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Bout-Tabaku S, Gupta R, Jenkins TM, Ryder JR, Baughcum AE, Jackson RD, Inge TH, Dixon JB, Helmrath MA, Courcoulas AP, Mitchell JE, Harmon CM, Xie C, Michalsky MP. Musculoskeletal Pain, Physical Function, and Quality of Life After Bariatric Surgery. Pediatrics 2019; 144:peds.2019-1399. [PMID: 31744891 PMCID: PMC6889948 DOI: 10.1542/peds.2019-1399] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/19/2019] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVES To evaluate the longitudinal effects of metabolic and bariatric surgery (MBS) on the prevalence of musculoskeletal and lower extremity (LE) pain, physical function, and health-related quality of life. METHODS The Teen Longitudinal Assessment of Bariatric Surgery study (NCT00474318) prospectively collected data on 242 adolescents undergoing MBS at 5 centers over a 3-year follow-up. Joint pain and physical function outcomes were assessed by using the Health Assessment Questionnaire Disability Index, Impact of Weight on Quality of Life - Kids, and the Short Form 36 Health Survey. Adolescents with Blount disease (n = 9) were excluded. RESULTS Prevalent musculoskeletal and LE pain were reduced by 40% within 12 months and persisted over 3 years. Adjusted models revealed a 6% lower odds of having musculoskeletal pain (odds ratio = 0.94, 95% confidence interval: 0.92-0.99) and a 10% lower odds of having LE pain (odds ratio = 0.90, 95% confidence interval: 0.86-0.95) per 10% reduction of BMI. The prevalence of poor physical function (Health Assessment Questionnaire Disability Index score >0) declined from 49% to <20% at 6 months (P < .05), Physical comfort and the physical component scores, measured by the Impact of Weight on Quality of Life - Kids and the Short Form 36 Health Survey, improved at 6 months postsurgery and beyond (P < .01). Poor physical function predicted persistent joint pain after MBS. CONCLUSIONS Joint pain, impaired physical function, and impaired health-related quality of life significantly improve after MBS. These benefits in patient-reported outcomes support the use of MBS in adolescents with severe obesity and musculoskeletal pain and suggest that MBS in adolescence may reverse and reduce multiple risk factors for future joint disease.
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Affiliation(s)
- Sharon Bout-Tabaku
- Sidra Medicine, Doha, Qatar; .,Weill Cornell Medicine-Qatar, Doha, Qatar
| | - Resmi Gupta
- Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Todd M. Jenkins
- Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Justin R. Ryder
- Medical School, University of Minnesota, Minneapolis, Minnesota
| | | | | | - Thomas H. Inge
- Children’s Hospital Colorado, Aurora, Colorado;,University of Colorado, Denver, Colorado
| | - John B. Dixon
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | | | | | - James E. Mitchell
- Sanford Research and School of Medicine and Health Sciences, University of North Dakota, Fargo, North Dakota
| | - Carroll M. Harmon
- Women and Children’s Hospital, Buffalo, New York;,University of Buffalo, Buffalo, New York; and
| | | | - Marc P. Michalsky
- Nationwide Children’s Hospital, Columbus, Ohio;,The Ohio State University, Columbus, Ohio
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19
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Kinematic Comparison of Aquatic- and Land-Based Stationary Exercises in Overweight and Normal Weight Children. Pediatr Exerc Sci 2019; 31:314-321. [PMID: 30596335 DOI: 10.1123/pes.2018-0188] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Revised: 10/31/2018] [Accepted: 11/11/2018] [Indexed: 11/18/2022]
Abstract
PURPOSE This study examined lower extremity kinematics in healthy weight (HW) and overweight (OW) children during water- and land-based stationary exercises (stationary running, frontal kick, and butt kick) at light submaximal intensity. METHODS Participants included OW (N = 10; body fat percentage: 34.97 [8.60]) and HW (N = 15; body fat percentage: 18.33 [4.87]) children, aged 10 to 13 years. Spatiotemporal data, lower extremity joint kinematics, and rating of perceived exertion (RPE) were collected during water- and land-based stationary exercises. Repeated measures analysis of variance compared kinematic variables and RPE between groups and environments. A polygon area function compared coordination patterns between environments. RESULTS RPE responses were significantly greater in OW than HW children on land (13.6 [0.7] vs 11.6 [0.7]; P < .001), whereas the RPE responses were similar between groups in water (11.2 [0.7] vs 11.1 [0.8]; P > .05). OW children were significantly more upright than HW children during land-based exercise, whereas there were no differences observed between groups during aquatic-based exercise. The duration of stance and swing phases, angular velocity, and cadence were significantly lower in water than on land. CONCLUSION Compared with HW children, OW children performed stationary exercises in a more upright posture on land, with higher RPE. However, these differences diminished in water. Aquatic-based exercise may be effective in minimizing the effects of excess mass on OW children's ability to complete physical activity.
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20
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Molina-Garcia P, Migueles JH, Cadenas-Sanchez C, Esteban-Cornejo I, Mora-Gonzalez J, Rodriguez-Ayllon M, Plaza-Florido A, Vanrenterghem J, Ortega FB. A systematic review on biomechanical characteristics of walking in children and adolescents with overweight/obesity: Possible implications for the development of musculoskeletal disorders. Obes Rev 2019; 20:1033-1044. [PMID: 30942558 DOI: 10.1111/obr.12848] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Revised: 02/11/2019] [Accepted: 02/18/2019] [Indexed: 12/30/2022]
Abstract
It is known that obesity is associated with biomechanical alterations during locomotor tasks, which is considered a potential risk factor for the development of musculoskeletal disorders (MSKD). However, the association of obesity with biomechanical alterations of walking in the early stages of life have not yet been systematically reviewed. Thus, this review aims to summarize the biomechanical characteristics of walking in children and adolescents with overweight/obesity (OW/OB) versus their normal-weight (NW) counterparts. PubMed and Web of Science were systematically searched until November 2018. We found strong and moderate evidence supporting biomechanical differences in the gait pattern of OW/OB with respect to NW. Based on strong evidence, the gait patterns of OW/OB present greater pelvis transversal plane motion, higher hip internal rotation, higher hip flexion, extension and abduction moments and power generation/absorption, greater knee abduction/adduction motion, and higher knee abduction/adduction moments and power generation/absorption. Based on moderate evidence, OW/OB walk with greater step width, longer stance phase, higher tibiofemoral contact forces, higher ankle plantarflexion moments and power generation, and greater gastrocnemius and soleus activation/forces. These biomechanical alterations during walking in OW/OB could play a major role in the onset and progression of MSKD.
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Affiliation(s)
- Pablo Molina-Garcia
- PROFITH "PROmoting FITness and Health through physical activity" research group, Department of Physical Education and Sports, Faculty of Sport Sciences, University of Granada, Granada, Spain.,Department of Rehabilitation Sciences, KU Leuven - University of Leuven, Leuven, Belgium
| | - Jairo H Migueles
- PROFITH "PROmoting FITness and Health through physical activity" research group, Department of Physical Education and Sports, Faculty of Sport Sciences, University of Granada, Granada, Spain
| | - Cristina Cadenas-Sanchez
- PROFITH "PROmoting FITness and Health through physical activity" research group, Department of Physical Education and Sports, Faculty of Sport Sciences, University of Granada, Granada, Spain
| | - Irene Esteban-Cornejo
- PROFITH "PROmoting FITness and Health through physical activity" research group, Department of Physical Education and Sports, Faculty of Sport Sciences, University of Granada, Granada, Spain.,Center for Cognitive and Brain Health, Department of Psychology, Northeastern University, Boston, Massachusetts
| | - Jose Mora-Gonzalez
- PROFITH "PROmoting FITness and Health through physical activity" research group, Department of Physical Education and Sports, Faculty of Sport Sciences, University of Granada, Granada, Spain
| | - Maria Rodriguez-Ayllon
- PROFITH "PROmoting FITness and Health through physical activity" research group, Department of Physical Education and Sports, Faculty of Sport Sciences, University of Granada, Granada, Spain
| | - Abel Plaza-Florido
- PROFITH "PROmoting FITness and Health through physical activity" research group, Department of Physical Education and Sports, Faculty of Sport Sciences, University of Granada, Granada, Spain
| | - Jos Vanrenterghem
- Department of Rehabilitation Sciences, KU Leuven - University of Leuven, Leuven, Belgium
| | - Francisco B Ortega
- PROFITH "PROmoting FITness and Health through physical activity" research group, Department of Physical Education and Sports, Faculty of Sport Sciences, University of Granada, Granada, Spain.,Department of Biosciences and Nutrition, Karolinska Institute, Solna, Sweden
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Expanding instrumented gait testing in the community setting: A portable, depth-sensing camera captures joint motion in older adults. PLoS One 2019; 14:e0215995. [PMID: 31091267 PMCID: PMC6519784 DOI: 10.1371/journal.pone.0215995] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Accepted: 04/11/2019] [Indexed: 01/08/2023] Open
Abstract
Background Currently, it is not feasible to obtain laboratory-based measures of joint motion in large numbers of older adults. We assessed the utility of a portable depth-sensing camera for quantifying hip and knee joint motion of older adults during mobility testing in the community. Methods Participants were 52 older adults enrolled in the Rush Memory and Aging Project, a community-based cohort study of aging. In a subset, we compared dynamic hip and knee flexion/extension obtained via the depth-sensing camera with that obtained concurrently using a laboratory-based optoelectronic motion capture system. Then we recorded participants’ annual instrumented gait assessment in the community setting with the depth-sensing camera and examined the inter-relationships of hip and knee range of motion (ROM) with mobility metrics derived from a wearable sensor and other mobility-related health measures. Results In the community, we successfully acquired joint motion from 49/52 participants using the depth-sensing camera. Hip and knee ROMs were related to diverse sensor-derived metrics of mobility performance (hip: Pearson’s r = 0.31 to 0.58; knee: Pearson’s r = 0.29 to 0.51), as well as daily physical activity, conventional motor measures, self-report hip and knee pain and dysfunction, mobility disability, and falls. Conclusions The depth-sensing camera’s high rate of successful data acquisition and correlations of its hip and knee ROMs with other mobility measures suggest that this device can provide a cost-efficient means of quantifying joint motion in large numbers of community-dwelling older adults who span the health spectrum.
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Horsak B, Schwab C, Baca A, Greber-Platzer S, Kreissl A, Nehrer S, Keilani M, Crevenna R, Kranzl A, Wondrasch B. Effects of a lower extremity exercise program on gait biomechanics and clinical outcomes in children and adolescents with obesity: A randomized controlled trial. Gait Posture 2019; 70:122-129. [PMID: 30851623 DOI: 10.1016/j.gaitpost.2019.02.032] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Revised: 02/25/2019] [Accepted: 02/26/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND Research highlights the detrimental effects of obesity on gait biomechanics and the accompanied risk of lower-extremity skeletal malalignments, increased joint stress, pain and discomfort. Individuals with obesity typically show increased knee valgus angles combined with an increased step width. Accompanying muscular dysfunctions impede their ability to compensate for these alterations, especially in the frontal plane. To date, no studies are available, which evaluated the potential effects of an exercise program (EP) in reducing these unfavorable biomechanical changes. RESEARCH QUESTIONS Is a 12-week EP, which includes hip abductor and knee extensor strength exercises and fosters dynamic knee alignment, effective in positively altering gait biomechanics in children and adolescents with obesity? METHODS This study was a randomized controlled trial having children and adolescents with obesity assigned to an EP (n = 19) or control (n = 16) group. Pain, self-rated knee function, muscle strength and 3D gait analysis during walking and stair climbing were evaluated. RESULTS Results indicate that the EP was able to increase muscular strength especially in the hip abductors. In addition, children from the EP group walked with less maximum hip adduction and reduced pelvic drop during weight acceptance at follow-up. No changes were present in self-rated knee function, pain or discomfort. SIGNIFICANCE Even though effects were small, results indicate that an EP is an effective short-term possibility to counteract the progressive development of biomechanical malalignments of the lower extremity. Clinical parameters indicated that the program was feasible. Nonetheless, low adherence highlights the need to develop more attractive programs. CLINICAL TRIALS REG. NO: clinicaltrials.gov (NCT02545764).
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Affiliation(s)
- B Horsak
- St. Pölten University of Applied Sciences, Institute of Health Sciences, St. Pölten, Austria.
| | - C Schwab
- St. Pölten University of Applied Sciences, Institute of Health Sciences, St. Pölten, Austria
| | - A Baca
- University of Vienna, Department of Biomechanics, Kinesiology and Computer Science in Sport, Vienna, Austria
| | - S Greber-Platzer
- Medical University of Vienna, Department of Pediatrics and Adolescent Medicine, Vienna, Austria
| | - A Kreissl
- Medical University of Vienna, Department of Pediatrics and Adolescent Medicine, Vienna, Austria
| | - S Nehrer
- Danube-University Krems, Center for Regenerative Medicine and Orthopedics, Krems, Austria
| | - M Keilani
- Medical University of Vienna, Department of Physical Medicine, Rehabilitation and Occupational Medicine, Vienna, Austria
| | - R Crevenna
- Medical University of Vienna, Department of Physical Medicine, Rehabilitation and Occupational Medicine, Vienna, Austria
| | - A Kranzl
- Orthopaedic Hospital Vienna-Speising, Laboratory of Gait and Movement Analysis, Vienna, Austria
| | - B Wondrasch
- St. Pölten University of Applied Sciences, Institute of Health Sciences, St. Pölten, Austria
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Abstract
Blount disease is an asymmetrical disorder of proximal tibial growth that produces a three-dimensional deformity. Tibia vara is the main component of the deformity. Blount disease exists as two clinical variants, infantile or early-onset, and adolescent or late-onset, defined based on whether the first manifestations develop before or after 10 years of age. The pathophysiological mechanisms are unclear. In the Americas and Caribbean, Blount disease chiefly affects black obese children. Without treatment, the prognosis is often severe, particularly in the infantile form due to the development of medial tibial epiphysiodesis at about 6 to 8 years of age. In other parts of the world, the associations with black ethnicity and obesity are less obvious and the prognosis is often less severe. A consensus exists about the optimal treatment in two situations: before 4 years of age, progressive Blount disease should be corrected, preferably by a simple osteotomy; and once medial tibial epiphysiodesis has developed, both a complementary epiphysiodesis and gradual external fixator correction of the other alignment abnormalities, rotational deformity, and limb length are required. After 4 years of age, the outcome in the individual patient is difficult to predict. Magnetic resonance imaging supplies information on the morphology and vascularisation of the growth regions, thereby helping to guide treatment decisions. In the adolescent form, morbid obesity limits the treatment options. Untreated Blount disease in adults is rarely encountered. A more common occurrence is the presence of residual abnormalities at skeletal maturity in patients treated for Blount disease in childhood. Premature osteoarthritis may develop. In this situation, osteotomy may delay the need for total knee arthroplasty.
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Affiliation(s)
- Marc Janoyer
- Service de chirurgie infantile, CHU de Martinique, Maison de la femme de la mère et de l'enfant, boîte postale 632, 97261 Fort-de-France cedex, Martinique.
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Abstract
PURPOSE This study examined differences in lower extremity kinematics and muscle activation patterns between normal weight (NW) and overweight (OW) children during stationary exercises (running in place, frontal kick, and butt kick) at submaximal intensity. METHODS Healthy children (aged 10-13 y) were stratified into OW (n = 10; body fat percentage: 34.97 [8.60]) and NW (n = 15; body fat percentage: 18.33 [4.87]). Electromyography was recorded for rectus femoris, vastus lateralis, biceps femoris, gastrocnemius, and tibialis anterior. In addition, the ratings of perceived exertion and range of motion of hip, knee, and ankle joints were collected during stationary exercises. Repeated-measures analysis of variance compared muscle activation, range of motion, and ratings of perceived exertion between groups and exercises. Friedman test examined sequencing of muscles recruitment. RESULTS Compared with NW, OW experienced significantly greater ratings of perceived exertion (13.7 [0.8] vs 11.7 [0.7]; P < .001) and electromyography amplitude in all muscles apart from vastus lateralis during stationary exercises. In addition, NW children used more consistent muscles' recruitment pattern in comparison with OW children. The range of motion was similar between groups at all joints. CONCLUSION OW children may adopt a more active neuromuscular strategy to provide greater stability and propulsion during stationary exercises. Stationary exercise can be prescribed to strengthen lower extremity muscles in OW children, but mode and intensity must be considered.
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25
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Silva FR, Muniz AMDS, Cerqueira LS, Nadal J. Biomechanical alterations of gait on overweight subjects. ACTA ACUST UNITED AC 2018. [DOI: 10.1590/2446-4740.180017] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Gait Pattern, Impact to the Skeleton and Postural Balance in Overweight and Obese Children: A Review. Sports (Basel) 2018; 6:sports6030075. [PMID: 30065150 PMCID: PMC6162717 DOI: 10.3390/sports6030075] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2018] [Revised: 07/18/2018] [Accepted: 07/26/2018] [Indexed: 12/13/2022] Open
Abstract
The article reviews the biomechanical factors that may cause overweight/obese children to reduce their level of physical activity, while increasing their risk of overuse injuries and exercise-related pain. Recommendations would be to screen those children for any gait or postural impairments before they join any exercise program, and to provide them with specific gait treatments and/or physical exercise programs, in order to decrease their risk for future musculoskeletal injuries and pain.
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Mahaffey R, Morrison SC, Bassett P, Drechsler WI, Cramp MC. Biomechanical characteristics of lower limb gait waveforms: Associations with body fat in children. Gait Posture 2018; 61:220-225. [PMID: 29413788 DOI: 10.1016/j.gaitpost.2018.01.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Revised: 01/18/2018] [Accepted: 01/21/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND Childhood obesity is associated with musculoskeletal dysfunction and altered lower limb biomechanics during gait. Few previous studies have explored relationships between childhood obesity measured by body fat and lower limb joint waveform kinematics and kinetics. RESEARCH QUESTION What is the association between body fat and hip, knee and ankle joint angles and moments during gait and in 7 to 11 year-old boys? METHODS Fifty-five boys participated in the study. Body fat was measured by air displacement plethysmography. Hip, knee and ankle 3D waveforms of joint angles and moments were recorded during gait. Principle component analysis was used to reduce the multidimensional nature of the waveform into components representing parts of the gait cycle. Multiple linear regression analysis determined the association between the components with body fat. RESULTS Higher body fat predicted greater hip flexion, knee flexion and knee internal rotation during late stance and greater ankle external rotation in late swing/early stance. Greater hip flexion and adduction moments were found in early stance with higher body fat. In mid-stance, greater knee adduction moments were associated with high body fat. Finally, at the ankle, higher body fat was predictive of greater internal rotation moments. SIGNIFICANCE The study presents novel information on relationships between body fat and kinematic and kinetic waveform analysis of paediatric gait. The findings suggest altered lower limb joint kinematics and kinetics with high body fat in young boys. The findings may help to inform research in to preventing musculoskeletal comorbidities and promoting weight management.
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Affiliation(s)
- Ryan Mahaffey
- School of Sport, Health and Applied Sciences, St Mary's University Twickenham, Waldegrave Rd, Twickenham, TW1 4SX, UK.
| | - Stewart C Morrison
- University of Brighton, School of Health Sciences, Darley Road, Eastbourne, BN20 7UR, UK.
| | - Paul Bassett
- Statsconsultancy Ltd., 40 Longwood Lane, Amersham, Bucks, HP7 9EN, UK.
| | - Wendy I Drechsler
- Faculty of Life Sciences & Medicine, Kings College London, London, SE1 1UL, UK.
| | - Mary C Cramp
- Department of Allied Health Professions, Glenside Campus, University of West England, Blackberry Hill, Bristol, BS16 1DD, UK.
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Trends in Attitudes and Practice Patterns of Physical Therapists in Addressing Childhood Obesity in Schools. Pediatr Phys Ther 2018; 30:40-48. [PMID: 29252836 DOI: 10.1097/pep.0000000000000466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE This study investigated trends in attitudes of school physical therapists about intervention for childhood obesity. METHODS A survey was developed to quantify attitudes. Two cases investigated the influence of attitudes on choices in treatment frequency. Factor analysis further delineated reasons for treatment frequency recommendations. RESULTS Attitudes did not change. Variability in responses decreased. Personal characteristics had evolving influence. In 2008, the perception of the PT's role in childhood obesity intervention had a greater influence on the choice to treat, but in 2015 the perception of the seriousness had a bigger effect on that decision. DISCUSSION Changing demographics of the therapists, increasing prevalence of obesity, and recent attention to the problem may have contributed to the trends. CONCLUSION There is no consensus as to the role of school physical therapy with intervention for obesity, but influential variables are emerging and practice patterns are evolving.
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Briggs MS, Bout-Tabaku S, McNally MP, Chaudhari AMW, Best TM, Schmitt LC. Relationships Between Standing Frontal-Plane Knee Alignment and Dynamic Knee Joint Loading During Walking and Jogging in Youth Who Are Obese. Phys Ther 2017; 97:571-580. [PMID: 28339815 DOI: 10.1093/ptj/pzx011] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/20/2017] [Indexed: 02/09/2023]
Abstract
BACKGROUND Youth who are obese have high risk of poor knee health and cartilage damage. Understanding factors which may affect knee health in youth who are obese is critical for preservation of knee integrity and function. OBJECTIVE This study compared standing frontal-plane knee alignment and knee loading patterns between youth who are obese and those of healthy weight and determine the association between knee alignment and knee loading patterns during walking and jogging. DESIGN This study used a cross-sectional matched pair design. METHODS Twenty youth who were obese and 20 youth who were healthy-weight (ages 11-18 years) were recruited. Three-dimensional motion analysis quantified standing frontal-plane knee alignment as well as frontal- and sagittal-plane knee moments during walking and jogging. Paired t -tests, multiple analysis of covariance, and Spearman's rank correlation coefficients were used for analysis. RESULTS The youth who were obese demonstrated greater knee valgus in standing ( P = 0.02), lower normalized peak external knee adduction moments during walking ( P = 0.003), and greater normalized peak external knee extension moments during jogging ( P = 0.003) compared with the youth who were healthy-weight. Standing knee alignment did not correlate with knee moments in the youth who were obese. LIMITATIONS Results are limited to small, homogeneous cohorts. The standing alignment methodology is not validated in this population and may limit interpretation of results. CONCLUSION Youth who are obese stand in more knee valgus and have altered knee loading patterns during walking and jogging compared with youth who are healthy-weight. Frontal-plane knee alignment does not correlate with frontal-plane knee loading patterns in youth who are obese. A better understanding of other mechanisms related to joint loading in youth who are obese is necessary to maintain long-term joint integrity in this population.
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Affiliation(s)
- Matthew S Briggs
- The Ohio State University Wexner Medical Center-OSU Sports Medicine, Sports Medicine Research Institute, and Department of Orthopaedics, Columbus, Ohio
| | - Sharon Bout-Tabaku
- Department of Pediatrics, Division of Rheumatology, Nationwide Children's Hospital, Columbus, Ohio
| | - Michael P McNally
- Health and Rehabilitation Sciences PhD Program, The Ohio State University
| | - Ajit M W Chaudhari
- Division of Physical Therapy, School of Health and Rehabilitation Sciences, College of Medicine, The Ohio State University
| | - Thomas M Best
- Department of Orthopedics, UHealth Sports Medicine Institute, University of Miami Miller School of Medicine
| | - Laura C Schmitt
- Division of Physical Therapy, School of Health and Rehabilitation Sciences, College of Medicine, The Ohio State University, 453 W 10th Ave, Columbus, OH 43221 (USA)
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Hora M, Soumar L, Pontzer H, Sládek V. Body size and lower limb posture during walking in humans. PLoS One 2017; 12:e0172112. [PMID: 28192522 PMCID: PMC5305206 DOI: 10.1371/journal.pone.0172112] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Accepted: 01/31/2017] [Indexed: 12/03/2022] Open
Abstract
We test whether locomotor posture is associated with body mass and lower limb length in humans and explore how body size and posture affect net joint moments during walking. We acquired gait data for 24 females and 25 males using a three-dimensional motion capture system and pressure-measuring insoles. We employed the general linear model and commonality analysis to assess the independent effect of body mass and lower limb length on flexion angles at the hip, knee, and ankle while controlling for sex and velocity. In addition, we used inverse dynamics to model the effect of size and posture on net joint moments. At early stance, body mass has a negative effect on knee flexion (p < 0.01), whereas lower limb length has a negative effect on hip flexion (p < 0.05). Body mass uniquely explains 15.8% of the variance in knee flexion, whereas lower limb length uniquely explains 5.4% of the variance in hip flexion. Both of the detected relationships between body size and posture are consistent with the moment moderating postural adjustments predicted by our model. At late stance, no significant relationship between body size and posture was detected. Humans of greater body size reduce the flexion of the hip and knee at early stance, which results in the moderation of net moments at these joints.
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Affiliation(s)
- Martin Hora
- Department of Anthropology and Human Genetics, Faculty of Science, Charles University, Prague, Czech Republic
- * E-mail:
| | - Libor Soumar
- CASRI - Sports Research Institute of Czech Armed Forces, Prague, Czech Republic
| | - Herman Pontzer
- Department of Anthropology, Hunter College, New York, New York, United States of America
| | - Vladimír Sládek
- Department of Anthropology and Human Genetics, Faculty of Science, Charles University, Prague, Czech Republic
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Meyns P, Van Gestel L, Bar-On L, Goudriaan M, Wambacq H, Aertbeliën E, Bruyninckx H, Molenaers G, De Cock P, Ortibus E, Desloovere K. Children with Spastic Cerebral Palsy Experience Difficulties Adjusting Their Gait Pattern to Weight Added to the Waist, While Typically Developing Children Do Not. Front Hum Neurosci 2016; 10:657. [PMID: 28123360 PMCID: PMC5226450 DOI: 10.3389/fnhum.2016.00657] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Accepted: 12/09/2016] [Indexed: 11/13/2022] Open
Abstract
The prevalence of childhood overweight and obesity is increasing in the last decades, also in children with Cerebral Palsy (CP). Even though it has been established that an increase in weight can have important negative effects on gait in healthy adults and children, it has not been investigated what the effect is of an increase in body weight on the characteristics of gait in children with CP. In CP, pre and post three-dimensional gait analyses are performed to assess the effectiveness of an intervention. As a considerable amount of time can elapse between these measurements, and the effect of an alteration in the body weight is not taken into consideration, this effect of increased body weight is of specific importance. Thirty children with the predominantly spastic type of CP and 15 typically developing (TD) children were enrolled (age 3-15 years). All children underwent three-dimensional gait analysis with weight-free (baseline) and weighted (10% of the body weight added around their waist) trials. Numerous gait parameters showed a different response to the added weight for TD and CP children. TD children increased walking velocity, step- and stride length, and decreased double support duration with a slightly earlier timing of foot-off, while the opposite was found in CP. Similarly, increased ranges of motion at the pelvis (coronal plane) and hip (all planes), higher joint angular velocities at the hip and ankle, as well as increased moments and powers at the hip, knee and ankle were observed for TD children, while CP children did not change or even showed decreases in the respective measures in response to walking with added weight. Further, while TD children increased their gastrocnemius EMG amplitude during weighted walking, CP children slightly decreased their gastrocnemius EMG amplitude. As such, an increase in weight has a significant effect on the gait pattern in CP children. Clinical gait analysts should therefore take into account the negative effects of increased weight during pre-post measurements to avoid misinterpretation of treatment results. Overweight and obesity in CP should be counteracted or prevented as the increased weight has detrimental effects on the gait pattern.
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Affiliation(s)
- Pieter Meyns
- Department of Rehabilitation Medicine, MOVE Research Institute Amsterdam, VU University Medical Center Amsterdam, Netherlands
| | - Leen Van Gestel
- Department of Rehabilitation Sciences, Faculty of Kinesiology and Rehabilitation Sciences KU Leuven, Leuven, Belgium
| | - Lynn Bar-On
- Department of Rehabilitation Sciences, Faculty of Kinesiology and Rehabilitation SciencesKU Leuven, Leuven, Belgium; Clinical Motion Analysis Laboratory, University Hospital LeuvenLeuven, Belgium
| | - Marije Goudriaan
- Department of Rehabilitation Sciences, Faculty of Kinesiology and Rehabilitation SciencesKU Leuven, Leuven, Belgium; Clinical Motion Analysis Laboratory, University Hospital LeuvenLeuven, Belgium
| | - Hans Wambacq
- Division of Production Engineering, Machine Design and Automation, Faculty of Engineering, Department of Mechanical Engineering, KU Leuven Leuven, Belgium
| | - Erwin Aertbeliën
- Division of Production Engineering, Machine Design and Automation, Faculty of Engineering, Department of Mechanical Engineering, KU Leuven Leuven, Belgium
| | - Herman Bruyninckx
- Division of Production Engineering, Machine Design and Automation, Faculty of Engineering, Department of Mechanical Engineering, KU Leuven Leuven, Belgium
| | - Guy Molenaers
- Clinical Motion Analysis Laboratory, University Hospital LeuvenLeuven, Belgium; Department of Pediatric Orthopaedics, University Hospital LeuvenLeuven, Belgium; Faculty of Medicine, Department of Musculoskeletal SciencesKU Leuven, Leuven, Belgium
| | - Paul De Cock
- Centre for Developmental Disabilities, University Hospital Leuven Leuven, Belgium
| | - Els Ortibus
- Centre for Developmental Disabilities, University Hospital Leuven Leuven, Belgium
| | - Kaat Desloovere
- Department of Rehabilitation Sciences, Faculty of Kinesiology and Rehabilitation SciencesKU Leuven, Leuven, Belgium; Clinical Motion Analysis Laboratory, University Hospital LeuvenLeuven, Belgium
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Tilinca M, Pop TS, Bățagă T, Zazgyva A, Niculescu M. Obesity and Knee Arthroscopy – a Review. JOURNAL OF INTERDISCIPLINARY MEDICINE 2016. [DOI: 10.1515/jim-2016-0048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Obesity is currently a global epidemic, often referred to as “globesity”, impacting the life of millions worldwide. A risk factor for many diseases, obesity can also be linked to developing intra-articular lesions of the knee, affecting the menisci, ligaments and cartilage. Furthermore, obesity has been shown to influence the outcome of surgical interventions, including those of the musculoskeletal system. Although many studies addressed the relationship of obesity and joint replacement, articles relating to arthroscopy and obesity, and knee arthroscopy in particular, are a bit scarcer. The majority of data suggest that an increase in BMI leads to a similar increase in the rates of intra- and postoperative complications, and most authors agree that a higher body mass index can influence both the procedure itself and its outcomes, including the subjective results reported by the patients. Still, some studies show different results, especially in patients that are overweight or with low-grade obesity, where the outcomes are comparable to those of the non-obese population. Thus, it can be concluded that obesity is an important patient characteristic that needs to be taken into consideration when planning, performing, and assessing the results of knee arthroscopy.
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Affiliation(s)
- Mariana Tilinca
- Department of Cell and Molecular Biology, Faculty of Medicine, University of Medicine and Pharmacy, Tîrgu Mureș, Romania
| | - Tudor Sorin Pop
- Department of Orthopedics and Traumatology I, Faculty of Medicine, University of Medicine and Pharmacy, Tîrgu Mureș, Romania
| | - Tiberiu Bățagă
- Department of Orthopedics and Traumatology II, Faculty of Medicine, University of Medicine and Pharmacy, Tîrgu Mureș, Romania
| | - Ancuța Zazgyva
- Department of Cell and Molecular Biology, Faculty of Medicine, University of Medicine and Pharmacy, Tîrgu Mureș, Str. Gheorghe Marinescu nr. 38 540139, Romania
| | - Marius Niculescu
- Department of Orthopedics and Traumatology, Faculty of Medicine, Titu Maiorescu University, Bucharest, Romania
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Singh B, Negatu MG, Francis SL, Janz KF, Yack HJ. Do fitness and fatigue affect gait biomechanics in overweight and obese children? Gait Posture 2016; 50:190-195. [PMID: 27637091 DOI: 10.1016/j.gaitpost.2016.09.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2016] [Revised: 08/15/2016] [Accepted: 09/07/2016] [Indexed: 02/02/2023]
Abstract
UNLABELLED The purpose of this study was to determine how an overweight or obese child's cardiorespiratory fitness level and a state of fatigue affect gait biomechanics. METHODS Using a three-dimensional motion analysis system, twenty-nine (female and male) overweight and obese children aged 8-11 years walked on force plates before and after being fatigued from the Progressive Aerobic Cardiovascular Endurance Run (PACER) protocol. Joint moments were calculated for the knee and hip in the frontal and sagittal planes. RESULTS In a non-fatigued state, peak hip and knee adductor moments showed a negative relationship with cardiorespiratory fitness level (R2=0.26, 0.26). After the subjects were fatigued, peak hip extensor (p=0.02), peak knee extensor moments (p=0.02) and peak knee adductor moments (p=0.01) showed a significant increase. CONCLUSION This trend illustrates that as an overweight or obese individual's fitness improves, the lower limb joint moments in the frontal plane decrease when walking. However, with the introduction of cardiorespiratory fatigue, lower limb joint moments tend to increase in the frontal and sagittal planes. Increased joint stress may have potential implications for obese children performing physical activity, as well as for clinicians who are attempting to intervene in the cycle of obesity.
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Affiliation(s)
- Bhupinder Singh
- Department of Physical Therapy, California State University, Fresno, United States.
| | - Megan G Negatu
- Department of Physical Therapy, California State University, Fresno, United States
| | - Shelby L Francis
- Department of Health and Human Physiology, University of Iowa, United States
| | - Kathleen F Janz
- Department of Health and Human Physiology, University of Iowa, United States
| | - H John Yack
- Department of Physical Therapy and Rehabilitation Sciences, University of Iowa, United States
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O'Neal EE, Plumert JM, McClure LA, Schwebel DC. The role of Body Mass Index in child pedestrian injury risk. ACCIDENT; ANALYSIS AND PREVENTION 2016; 90:29-35. [PMID: 26890078 PMCID: PMC4827859 DOI: 10.1016/j.aap.2016.02.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Revised: 01/24/2016] [Accepted: 02/01/2016] [Indexed: 06/05/2023]
Abstract
The goal of the current investigation was to examine obesity as a potential risk factor for childhood pedestrian injury. A racially diverse sample of 7- and 8-year-old children completed a road-crossing task in a semi-immersive virtual environment and two pedestrian route selection tasks. Multiple linear regression analyses revealed that children with a higher Body Mass Index (BMI) waited less before crossing, had a smaller temporal buffer between themselves and oncoming traffic while crossing, and had more collisions with traffic. Girls were more cautious than boys when crossing the virtual roadway. Unlike the results from the virtual road-crossing task, BMI was not associated with risky route selection. Instead, race emerged as the strongest predictor, with African-American children selecting riskier routes for crossing. Together, these findings suggest overweight and obese children may be at increased risk for pedestrian injury. The discussion considers explanations for why obese children may exhibit riskier road-crossing behavior.
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Affiliation(s)
- Elizabeth E O'Neal
- The University of Iowa, 11 Seashore Hall East, Iowa City, IA 52242, USA.
| | - Jodie M Plumert
- The University of Iowa, 11 Seashore Hall East, Iowa City, IA 52242, USA
| | - Leslie A McClure
- University of Alabama at Birmingham, Heritage Hall 571, 1720 2nd Ave S, Birmingham, AL 35233, USA
| | - David C Schwebel
- University of Alabama at Birmingham, Heritage Hall 571, 1720 2nd Ave S, Birmingham, AL 35233, USA
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MacLean KF, Callaghan JP, Maly MR. Effect of obesity on knee joint biomechanics during gait in young adults. COGENT MEDICINE 2016. [DOI: 10.1080/2331205x.2016.1173778] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Affiliation(s)
- Kathleen F.E. MacLean
- Department of Kinesiology, University of Waterloo, 200 University Ave W, Waterloo, Canada
| | - Jack P. Callaghan
- Department of Kinesiology, University of Waterloo, 200 University Ave W, Waterloo, Canada
| | - Monica R. Maly
- Department of Rehabilitation Sciences, McMaster University, Room 435 Institutes of Applied Health Sciences, 1400 Main Street West, Hamilton, Ontario, Canada L8S 1C7
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Pascoe J, Thomason P, Graham HK, Reddihough D, Sabin MA. Body mass index in ambulatory children with cerebral palsy: A cohort study. J Paediatr Child Health 2016; 52:417-21. [PMID: 27145505 DOI: 10.1111/jpc.13097] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2015] [Revised: 09/14/2015] [Accepted: 10/26/2015] [Indexed: 11/26/2022]
Abstract
AIM Children with cerebral palsy (CP) have reduced levels of physical activity compared with children without physical disability and experience risk factors for becoming overweight or obese. In the Australian CP population, there is little information available about the weight status of children with CP. The aims of this study were to compare the distribution of body mass index (BMI) in a cohort of ambulant children with CP with the BMI distribution of Australian children and explore the relationship between BMI and gross motor function. METHODS A retrospective cohort study of 587 children with CP Gross Motor Function Classification System (GMFCS) levels I-III who attended a Gait Laboratory between July 1995 and January 2012 was carried out. The BMI and Z-score were calculated at each assessment. Data were grouped into the categories of underweight, healthy, overweight and obese according to age-specific and sex-specific percentiles. RESULTS There were 348 boys and 240 girls with a mean age 11.2 (standard deviation 3.2) years. Mean BMI Z-score was 0.11 (standard deviation 1.33). Seven percent of children were underweight, 73.6% healthy, 7.3% overweight and 12.1% obese. This was similar to the distribution of children without disability. The largest percentage of children in the healthy group were classified GMFCS I. The largest percentage of children in the obese group were classified GMFCS III. CONCLUSIONS In this cohort, 19.4% of ambulant children with CP were overweight or obese. This is of concern as BMI may impact on the outcomes of surgical intervention and rehabilitation. Further research is needed to determine the consequences of obesity for children with CP.
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Affiliation(s)
- Jessica Pascoe
- Hugh Williamson Gait Analysis Laboratory, Royal Children's Hospital, Melbourne, Australia
| | - Pam Thomason
- Hugh Williamson Gait Analysis Laboratory, Royal Children's Hospital, Melbourne, Australia.,Murdoch Childrens Research Institute, Melbourne, Australia
| | - H Kerr Graham
- Hugh Williamson Gait Analysis Laboratory, Royal Children's Hospital, Melbourne, Australia.,Murdoch Childrens Research Institute, Melbourne, Australia.,The University of Melbourne, Melbourne, Australia
| | - Dinah Reddihough
- Murdoch Childrens Research Institute, Melbourne, Australia.,The University of Melbourne, Melbourne, Australia.,Department of Developmental Medicine, Royal Children's Hospital, Melbourne, Australia
| | - Matthew A Sabin
- Murdoch Childrens Research Institute, Melbourne, Australia.,The University of Melbourne, Melbourne, Australia.,Department of Endocrinology and Diabetes, Royal Children's Hospital, Melbourne, Australia
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Lerner ZF, Board WJ, Browning RC. Pediatric obesity and walking duration increase medial tibiofemoral compartment contact forces. J Orthop Res 2016; 34:97-105. [PMID: 26271943 DOI: 10.1002/jor.23028] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2015] [Accepted: 08/11/2015] [Indexed: 02/04/2023]
Abstract
With the high prevalence of pediatric obesity there is a need for structured physical activity during childhood. However, altered tibiofemoral loading during physical activity in obese children likely contribute to their increased risk of orthopedic disorders of the knee. The goal of this study was to determine the effects of pediatric obesity and walking duration on medial and lateral tibiofemoral contact forces. We collected experimental biomechanics data during treadmill walking at 1 m•s(-1) for 20 min in 10 obese and 10 healthy-weight 8-12 year-olds. We created subject-specific musculoskeletal models using radiographic measures of tibiofemoral alignment and centers-of-pressure, and predicted medial and lateral tibiofemoral contact forces at the beginning and end of each trial. Obesity and walking duration affected tibiofemoral loading. At the beginning of the trail, the average percent of the total load passing through the medial compartment during stance was 85% in the obese children and 63% in the healthy-weight children; at the end of the trial, the medial distribution was 90% in the obese children and 72% in the healthy-weight children. Medial compartment loading rates were 1.78 times greater in the obese participants. The medial compartment loading rate increased 17% in both groups at the end compared to the beginning of the trial (p = 0.001). We found a strong linear relationship between body-fat percentage and the medial-lateral load distribution (r(2) = 0.79). Altered tibiofemoral loading during walking in obese children may contribute to their increased risk of knee pain and pathology.
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Affiliation(s)
- Zachary F Lerner
- Functional and Applied Biomechanics Section, Rehabilitation Medicine Department, National Institutes of Health, Bethesda, Maryland.,School of Biomedical Engineering, Colorado State University, Fort Collins, Colorado
| | - Wayne J Board
- Department of Health and Exercise Science, Colorado State University, Fort Collins, Colorado
| | - Raymond C Browning
- School of Biomedical Engineering, Colorado State University, Fort Collins, Colorado.,Department of Health and Exercise Science, Colorado State University, Fort Collins, Colorado
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Horsak B, Artner D, Baca A, Pobatschnig B, Greber-Platzer S, Nehrer S, Wondrasch B. The effects of a strength and neuromuscular exercise programme for the lower extremity on knee load, pain and function in obese children and adolescents: study protocol for a randomised controlled trial. Trials 2015; 16:586. [PMID: 26700568 PMCID: PMC4690219 DOI: 10.1186/s13063-015-1091-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Accepted: 11/27/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Childhood obesity is one of the most critical and accelerating health challenges throughout the world. It is a major risk factor for developing varus/valgus misalignments of the knee joint. The combination of misalignment at the knee and excess body mass may result in increased joint stresses and damage to articular cartilage. A training programme, which aims at developing a more neutral alignment of the trunk and lower limbs during movement tasks may be able to reduce knee loading during locomotion. Despite the large number of guidelines for muscle strength training and neuromuscular exercises that exist, most are not specifically designed to target the obese children and adolescent demographic. Therefore, the aim of this study is to evaluate a training programme which combines strength and neuromuscular exercises specifically designed to the needs and limitations of obese children and adolescents and analyse the effects of the training programme from a biomechanical and clinical point of view. METHODS/DESIGN A single assessor-blinded, pre-test and post-test randomised controlled trial, with one control and one intervention group will be conducted with 48 boys and girls aged between 10 and 18 years. Intervention group participants will receive a 12-week neuromuscular and quadriceps/hip strength training programme. Three-dimensional (3D) gait analyses during level walking and stair climbing will be performed at baseline and follow-up sessions. The primary outcome parameters for this study will be the overall peak external frontal knee moment and impulse during walking. Secondary outcomes include the subscales of the Knee injury and Osteoarthritis Outcome Score (KOOS), frontal and sagittal kinematics and kinetics for the lower extremities during walking and stair climbing, ratings of change in knee-related well-being, pain and function and adherence to the training programme. In addition, the training programme will be evaulated from a clinical and health status perspective by including the following analyses: cardiopulmonary testing to quantify aerobic fitness effects, anthropometric measures, nutritional status and psychological status to characterise the study sample. DISCUSSION The findings will help to determine whether a neuromuscular and strength training exercise programme for the obese children population can reduce joint loading during locomotion, and thereby decrease the possible risk of developing degenerative joint diseases later in adulthood. TRIAL REGISTRATION ClinicalTrials NCT02545764 , Date of registration: 24 September 2015.
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Affiliation(s)
- Brian Horsak
- Department of Physiotherapy, St. Pölten University of Applied Sciences, St. Pölten, Austria.
| | - David Artner
- Department of Physiotherapy, St. Pölten University of Applied Sciences, St. Pölten, Austria.
| | - Arnold Baca
- Department of Biomechanics, Kinesiology and Applied Computer Science, University of Vienna, Vienna, Austria.
| | - Barbara Pobatschnig
- Department of Biomechanics, Kinesiology and Applied Computer Science, University of Vienna, Vienna, Austria.
| | - Susanne Greber-Platzer
- Department of Paediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria.
| | - Stefan Nehrer
- Centre for Regenerative Medicine and Orthopaedics, Danube University Krems, Krems, Austria.
| | - Barbara Wondrasch
- Department of Physiotherapy, St. Pölten University of Applied Sciences, St. Pölten, Austria.
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Amiri P, Hubley-Kozey CL, Landry SC, Stanish WD, Astephen Wilson JL. Obesity is associated with prolonged activity of the quadriceps and gastrocnemii during gait. J Electromyogr Kinesiol 2015; 25:951-8. [PMID: 26559464 DOI: 10.1016/j.jelekin.2015.10.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Revised: 08/21/2015] [Accepted: 10/13/2015] [Indexed: 12/22/2022] Open
Abstract
PURPOSE To examine the effect of obesity and its potential interaction with knee OA presence on the electromyography patterns of the major knee joint periarticular muscles during walking. SCOPE One hundred and eighteen asymptomatic adults and 177 adults with moderate knee osteoarthritis were subdivided into categories of healthy weight (n = 77; 20 kg/m(2) < BMI < 25 kg/m(2)), overweight (n = 117; 25 kg/m(2) ⩽ BMI < 30 kg/m(2)), and obese (n = 101; BMI ⩾ 30 kg/m(2) based on their body mass index (BMI). All individuals underwent a three-dimensional gait analysis. Surface electromyograms from the lateral and medial gastrocnemii, lateral and medial hamstrings, vastus lateralis, vastus medialis, and rectus femoris were recorded during self-selected speed walking. Principal component analysis was used to extract major features of amplitude and temporal pattern variability from the electromyograms of each muscle group (gastrocnemii, quadriceps, hamstrings separately). Analysis of variance models tested for main BMI category effects and interaction effects for these features (α = 0.05). Statistically significant BMI category (i.e. obesity) effects were found for features that described more prolonged activations of the gastrocnemii and quadriceps muscles during the stance phase of gait with obesity (P < 0.05). CONCLUSIONS Obesity was associated with prolonged activation of quadriceps and gastrocnemii, which can result in prolonged knee joint contact loading, and thereby may contribute to the predisposition of knee OA development and progression in obese individuals.
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Affiliation(s)
- P Amiri
- School of Biomedical Engineering, Dalhousie University, Halifax, NS, Canada
| | - C L Hubley-Kozey
- School of Physiotherapy, Dalhousie University, Halifax, NS, Canada; School of Biomedical Engineering, Dalhousie University, Halifax, NS, Canada
| | - S C Landry
- School of Kinesiology, Acadia University, Wolfville, NS, Canada; School of Biomedical Engineering, Dalhousie University, Halifax, NS, Canada
| | - W D Stanish
- Department of Surgery, Division of Orthopedics, Dalhousie University, Halifax, NS, Canada; School of Biomedical Engineering, Dalhousie University, Halifax, NS, Canada
| | - J L Astephen Wilson
- School of Biomedical Engineering, Dalhousie University, Halifax, NS, Canada.
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Thivel D, Isacco L, O’Malley G, Duché P. Pediatric Obesity and Perceived Exertion: Difference Between Weight-Bearing and Non-Weight-Bearing Exercises Performed at Different Intensities. J Sports Sci 2015; 34:389-94. [DOI: 10.1080/02640414.2015.1061200] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Bout-Tabaku S, Michalsky MP, Jenkins TM, Baughcum A, Zeller MH, Brandt ML, Courcoulas A, Buncher R, Helmrath M, Harmon CM, Chen MK, Inge TH. Musculoskeletal Pain, Self-reported Physical Function, and Quality of Life in the Teen-Longitudinal Assessment of Bariatric Surgery (Teen-LABS) Cohort. JAMA Pediatr 2015; 169:552-9. [PMID: 25915190 PMCID: PMC4551432 DOI: 10.1001/jamapediatrics.2015.0378] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
IMPORTANCE Obesity is associated with chronic musculoskeletal pain and is a risk factor for disability and osteoarthritis. OBJECTIVES To describe the prevalence, sites, and intensity of musculoskeletal pain in adolescents with severe obesity; to evaluate associations between musculoskeletal pain and self-reported physical function as well as weight-related quality of life; and to evaluate the association between musculoskeletal pain and high-sensitivity C-reactive protein level. DESIGN, SETTING, AND PARTICIPANTS Teen-Longitudinal Assessment of Bariatric Surgery (Teen-LABS) is a prospective, observational study that collects standardized data on adolescents undergoing weight loss surgery at 5 US centers. We examined baseline data from this cohort between February 28, 2007, and December 30, 2011. We excluded adolescents with Blount disease and slipped capital femoral epiphyses. A total of 233 participants were included in these analyses. MAIN OUTCOMES AND MEASURES We assessed musculoskeletal pain and pain intensity of the lower back, hips, knees, and ankles/feet using the visual analog scale, categorizing musculoskeletal pain into lower back pain, lower extremity (hips, knees, and feet/ankles combined) pain, and no pain. We assessed self-reported physical function status with the Health Assessment Questionnaire Disability Index and assessed weight-related quality of life with the Impact of Weight on Quality of Life-Kids measure. We adjusted for sex, race, age at surgery, body mass index (BMI; calculated as weight in kilograms divided by height in meters squared), and clinical depressive symptoms in regression analyses. RESULTS Among the 233 participants, the mean (SD) age at surgery was 17.1 (1.56) years and the median BMI was 50.4. Participants were predominantly female (77%), white (73%), and non-Hispanic (93%). Among the participants, 49% had poor functional status and 76% had musculoskeletal pain. Lower back pain was prevalent (63%), followed by ankle/foot (53%), knee (49%), and hip (31%) pain; 26% had pain at all 4 sites. In adjusted analyses, compared with pain-free participants, those reporting lower extremity pain had greater odds of having poor physical function according to scores on the Health Assessment Questionnaire Disability Index (odds ratio = 2.82; 95% CI, 1.35 to 5.88; P < .01). Compared with pain-free participants, those reporting lower extremity pain had significantly lower Impact of Weight on Quality of Life-Kids total scores (β = -9.42; 95% CI, -14.15 to -4.69; P < .01) and physical comfort scores (β = -17.29; 95% CI, -23.32 to -11.25; P < .01). After adjustment, no significant relationship was observed between musculoskeletal pain and high-sensitivity C-reactive protein level. CONCLUSIONS AND RELEVANCE Adolescents with severe obesity have musculoskeletal pain that limits their physical function and quality of life. Longitudinal follow-up will reveal whether weight loss surgery reverses pain and physical functional limitations and improves quality of life.
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Affiliation(s)
| | - Marc P Michalsky
- Nationwide Children's Hospital, The Ohio State University, Columbus
| | - Todd M Jenkins
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Amy Baughcum
- Nationwide Children's Hospital, The Ohio State University, Columbus
| | - Meg H Zeller
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Mary L Brandt
- Texas Children's Hospital, Baylor College of Medicine, Houston
| | - Anita Courcoulas
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | | | | | | | - Mike K Chen
- University of Alabama at Birmingham, Birmingham
| | - Thomas H Inge
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
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Farr S, Kranzl A, Pablik E, Kaipel M, Ganger R. Functional and radiographic consideration of lower limb malalignment in children and adolescents with idiopathic genu valgum. J Orthop Res 2014; 32:1362-70. [PMID: 25042523 DOI: 10.1002/jor.22684] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2014] [Accepted: 06/10/2014] [Indexed: 02/04/2023]
Abstract
Three-dimensional gait analysis is capable of assessing dynamic load characteristics and the resulting compensatory effects of lower limb malalignment, which are generally not reflected in static imaging. This study determined differences in gait parameters in the frontal and transverse plane between patients and controls in order to identify compensatory mechanisms, and to correlate radiographic measurements and gait parameters in a consecutive series of children with idiopathic genu valgum. Thirty-three patients (mean age 12.3 years) were retrospectively reviewed and compared to a healthy control group. Children with genu valgum demonstrated significantly decreased internal knee valgus moments, shifting into varus moments. Furthermore, significantly different transverse plane gait patterns (decreased external knee rotation, increased external hip rotation) were observed. These patterns showed a relevant influence on the frontal knee moments, with knee rotation and foot progression angle showing the highest predictive value for changes and possible compensation of frontal knee moments. The correlation between commonly used radiographic measurements (i.e., mechanical axis deviation) and findings of the gait analysis was only low. Besides showing decreased internal knee valgus moments, our results suggest that considerable compensatory gait mechanisms may be present in children with idiopathic genu valgum to reduce joint loading.
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Affiliation(s)
- Sebastian Farr
- Department of Pediatric Orthopaedics, Deformity Correction and Adult Foot & Ankle Surgery, Orthopaedic Hospital Vienna-Speising, Vienna, Austria
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Lerner ZF, Shultz SP, Board WJ, Kung S, Browning RC. Does adiposity affect muscle function during walking in children? J Biomech 2014; 47:2975-82. [DOI: 10.1016/j.jbiomech.2014.07.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2014] [Revised: 07/03/2014] [Accepted: 07/07/2014] [Indexed: 12/18/2022]
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Abstract
However quantified, obesity is a global health problem of significant magnitude. The condition is no longer limited to the developed world, with an increasing proportion of low-to-middle income countries burdened by obesity and its comorbidities. Specifically, obesity is a risk factor for a raft of psychosocial, physiological, cardiovascular, and metabolic problems. The carriage of excess body weight, including an unhealthy proportion of body fat, also has important implications for musculoskeletal health. To date, this important relationship has not received as much attention by the research community. Coincidentally, there has been a heightened interest in the role of physical activity and exercise across the lifespan in the prevention, treatment and management of obesity. This paper considers some of the more common musculoskeletal problems in children, adolescents and adults with implications for the overweight and obese and their meaningful engagement in physical activity.
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Affiliation(s)
- Sarah P Shultz
- School of Sport and Exercise, Massey University, 63 Wallace Street, Mt Cook, Wellington, 6140, New Zealand.
| | - Nuala M Byrne
- Institute of Sport and Exercise, Bond University, Robina, Australia.
| | - Andrew P Hills
- Centre for Nutrition and Exercise, Mater Research Institute - The University of Queensland and Griffith Health Institute, Griffith University, Nathan, Australia.
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The role of excess mass in the adaptation of children’s gait. Hum Mov Sci 2014; 36:12-9. [DOI: 10.1016/j.humov.2014.05.002] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2013] [Revised: 05/08/2014] [Accepted: 05/08/2014] [Indexed: 12/13/2022]
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The effects of pediatric obesity on dynamic joint malalignment during gait. Clin Biomech (Bristol, Avon) 2014; 29:835-8. [PMID: 24889987 DOI: 10.1016/j.clinbiomech.2014.05.004] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2013] [Revised: 05/14/2014] [Accepted: 05/14/2014] [Indexed: 02/07/2023]
Abstract
BACKGROUND There is a greater prevalence of lower extremity malalignment in obese children during static posture; however, there has been less examination of dynamic joint function in this cohort. Therefore, the purpose of this study was to determine kinematic differences that exist between obese and non-obese children that would support previously reported static joint malalignment. METHODS Forty children were classified as obese (n=20) or non-obese (n=20). Lower extremity joint kinematics were collected during five walking trials at a self-selected pace. Peak joint displacement and amount of joint motion throughout the gait cycle (calculated as the integrated displacement curve) were analyzed for group differences. FINDINGS Non-obese children had greater peak knee and hip extension during gait; however, there were no group differences in the integrated sagittal displacement curve. Obese children had greater peak angular displacement and integrals of angular displacement for peak hip adduction, hip internal rotation, and foot abduction (toe-out) than non-obese children. Obese children also had greater peak knee external rotation than non-obese children. INTERPRETATION Non-obese children showed greater range of motion in the sagittal plane, particularly at the hip and knee. Frontal and transverse plane differences suggest that obese children function in a more genu valgum position than non-obese children. Static measures of genu valgum have been previously associated with pediatric obesity; the findings indicate that there are also dynamic implications of said malalignment in obese children. Genu valgum presents increased risk of osteoarthritis for obese children and should be considered when prescribing weight bearing exercise to this cohort.
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Vincent HK, Vincent KR, Seay AN, Hurley RW. Functional impairment in obesity: a focus on knee and back pain. Pain Manag 2014; 1:427-39. [PMID: 24645710 DOI: 10.2217/pmt.11.39] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
SUMMARY Cross-sectional and longitudinal evidence strongly indicate that obesity is related to physical impairment and joint pain, particularly in the lumbar spine, sacroiliac and knee joints. What is most disturbing is that obese children under 15 years are now reporting joint pain and cannot perform functional tasks as well as their nonobese counterparts. As the prevalence of obesity rises, so do the rates of musculoskeletal disease and physical dysfunction. Functional tasks that involve supporting or transferring body weight are typically painful and difficult to perform. Of most concern is that some of these tasks are simply impossible depending on the severity of obesity. As a consequence, the individual's quality of life suffers. A BMI of 35 kg/m(2) is emerging as the threshold at which functional impairment rates rise dramatically. To restore functional independence and optimize functional gains over the long term, a combination of treatments for the obese patient with joint pain may be effective. The initial use of physical therapy, pain medications or joint viscosupplementation, coupled with diet, exercise, or bariatric surgery are options for weight loss and reduction of pain symptoms. Irrespective of age, weight loss can reduce or eliminate joint pain. As body weight is reduced, so should the reliance on medication with a concomitant improvement in functional mobility.
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Affiliation(s)
- Heather K Vincent
- Department of Orthopaedics & Rehabilitation, Departments of Anesthesiology, Neurology & Psychiatry, University of Florida, Gainesville, FL 32611, USA; Department of Orthopaedics & Rehabilitation, Division of Research, UF Orthopaedics & Sports Medicine Institute, PO Box 112727, Gainesville, FL 32611, USA
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Widmyer MR, Utturkar GM, Leddy HA, Coleman JL, Spritzer CE, Moorman CT, DeFrate LE, Guilak F. High body mass index is associated with increased diurnal strains in the articular cartilage of the knee. ACTA ACUST UNITED AC 2014; 65:2615-22. [PMID: 23818303 DOI: 10.1002/art.38062] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2013] [Accepted: 06/10/2013] [Indexed: 11/10/2022]
Abstract
OBJECTIVE Obesity is an important risk factor for osteoarthritis (OA) and is associated with changes in both the biomechanical and inflammatory environments within the joint. However, the relationship between obesity and cartilage deformation is not fully understood. The goal of this study was to determine the effects of body mass index (BMI) on the magnitude of diurnal cartilage strain in the knee. METHODS Three-dimensional maps of knee cartilage thickness were developed from 3T magnetic resonance images of the knees of asymptomatic age- and sex-matched subjects with normal BMI (18.5-24.9 kg/m2) or high BMI (25-31 kg/m2). Site-specific magnitudes of diurnal cartilage strain were determined using aligned images recorded at 8:00 AM and 4:00 PM on the same day. RESULTS Subjects with high BMI had significantly thicker cartilage on both the patella and femoral groove, as compared to subjects with normal BMI. Diurnal cartilage strains were dependent on location in the knee joint, as well as BMI. Subjects with high BMI, compared to those with normal BMI, exhibited significantly higher compressive strains in the tibial cartilage. Cartilage thickness on both femoral condyles decreased significantly from the AM to the PM time point; however, there was no significant effect of BMI on diurnal cartilage strain in the femur. CONCLUSION Increased BMI is associated with increased diurnal strains in articular cartilage of both the medial and lateral compartments of the knee. The increased cartilage strains observed in individuals with high BMI may, in part, explain the elevated risk of OA associated with obesity or may reflect alterations in the cartilage mechanical properties in subjects with high BMI.
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Affiliation(s)
- Margaret R Widmyer
- Duke University and Duke University Medical Center, Durham, North Carolina
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Abstract
PURPOSE Children with Blount disease are often obese and have muliplanar limb deformities including leg length discrepancy. Surgical options for these skeletally immature patients include guided growth and realignment osteotomy. Suboptimal outcomes such as persistent valgus overcorrection after proximal tibial osteotomy in children with early-onset Blount disease and undercorrection after guided growth treatment among adolescents with late-onset Blount disease can occur. Although obesity has been associated with precocious puberty, whether children with Blount disease have advanced skeletal maturity has not been previously investigated. We hypothesized that compared to their peers, children with Blount disease will have advanced skeletal (bone) age. METHODS The relationship between skeletal and chronologic age was compared between 33 patients with Blount disease (12 early-onset, 21 late-onset) and 33 age-matched and sex-matched controls. The influence of variables such as the age of onset of Blount disease and patient's chronologic age on the discrepancy between skeletal and chronologic age was also evaluated. RESULTS The mean body mass index was 39 kg/m2 in the Blount disease group and 23 kg/m2 in the control subjects (P<0.0001). Compared to their chronologic age, the bone age was advanced 16 months in Blount disease group (95% confidence interval, 10-22 mo) and 5 months in the control group (95% confidence interval, -1-10; P=0.003). On the basis of subgroup analysis, the bone age was advanced 26 months in early-onset and 10 months in late-onset Blount disease (P=0.01). The discrepancy between bone age and chronologic age decreased as chronologic age increased in both the control (r=-0.36, P=0.04) and Blount disease groups (r=-0.58, P=0.0004). CONCLUSION Compared to their peers, children with Blount disease have advanced skeletal maturity. The difference between bone age and chronologic age decreases with growth. Since advanced skeletal maturity can impact the strategy for surgical realignment and magnitude of planned (over)correction of lower limb deformity, preoperative assessment of bone age should be considered when managing children with Blount disease. LEVEL OF EVIDENCE Level III.
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