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Vandekerckhove I, Papageorgiou E, Hanssen B, De Beukelaer N, Van den Hauwe M, Goemans N, Van Campenhout A, De Waele L, De Groote F, Desloovere K. Gait classification for growing children with Duchenne muscular dystrophy. Sci Rep 2024; 14:10828. [PMID: 38734731 PMCID: PMC11088636 DOI: 10.1038/s41598-024-61231-y] [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: 08/31/2023] [Accepted: 05/02/2024] [Indexed: 05/13/2024] Open
Abstract
Classifying gait patterns into homogeneous groups could enhance communication among healthcare providers, clinical decision making and clinical trial designs in boys with Duchenne muscular dystrophy (DMD). Sutherland's classification has been developed 40 years ago. Ever since, the state-of-the-art medical care has improved and boys with DMD are now longer ambulatory. Therefore, the gait classification requires an update. The overall aim was to develop an up-to-date, valid DMD gait classification. A total of 137 three-dimensional gait analysis sessions were collected in 30 boys with DMD, aged 4.6-17 years. Three classes were distinguished, which only partly aligned with increasing severity of gait deviations. Apart from the mildly affected pattern, two more severely affected gait patterns were found, namely the tiptoeing pattern and the flexion pattern with distinct anterior pelvic tilt and posterior trunk leaning, which showed most severe deviations at the ankle or at the proximal segments/joints, respectively. The agreement between Sutherland's and the current classification was low, suggesting that gait pathology with the current state-of-the-art medical care has changed. However, overlap between classes, especially between the two more affected classes, highlights the complexity of the continuous gait changes. Therefore, caution is required when classifying individual boys with DMD into classes.
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Affiliation(s)
| | | | - Britta Hanssen
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| | - Nathalie De Beukelaer
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
- Department of Surgery, University of Geneva, Geneva, Switzerland
| | - Marleen Van den Hauwe
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
- Department of Child Neurology, University Hospital Leuven, Leuven, Belgium
| | - Nathalie Goemans
- Department of Child Neurology, University Hospital Leuven, Leuven, Belgium
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
| | - Anja Van Campenhout
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
- Department of Orthopedics, University Hospital Leuven, Leuven, Belgium
| | - Liesbeth De Waele
- Department of Child Neurology, University Hospital Leuven, Leuven, Belgium
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
| | | | - Kaat Desloovere
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
- Clinical Motion Analysis Laboratory, University Hospital Leuven, Pellenberg, Belgium
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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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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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Shultz SP, Buck AN, Fink PW, Kung SM, Ward MJ, Antal Z, Backus SI, Kraszewski AP, Hillstrom HJ. Body mass affects kinetic symmetry and inflammatory markers in adolescent knees during gait. Clin Biomech (Bristol, Avon) 2023; 102:105887. [PMID: 36657189 PMCID: PMC9975061 DOI: 10.1016/j.clinbiomech.2023.105887] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 12/20/2022] [Accepted: 01/09/2023] [Indexed: 01/12/2023]
Abstract
BACKGROUND Early-onset osteoarthritis has been attributed to pro-inflammatory factors and biomechanical changes in obesity. However, research has yet to explore whether knee joint moments are asymmetrical in children with obesity and could precede the onset of knee osteoarthritis. The present study compares knee moment asymmetry between adolescents with and without obesity and examines the relationship between asymmetries and inflammatory biomarkers. METHODS Twenty-eight adolescents (13-16 years) were classified as with (n = 12) or without (n = 16) obesity. Lower extremity kinetics were measured using three-dimensional motion analysis. Bilateral knee joint moments were analyzed in the sagittal, frontal, and transverse planes across stance phase. Kinetic asymmetry was calculated between the right and left sides and represented by the R2 value. Enzyme-linked immunosorbent assays analyzed serum 25-hydroxy vitamin D, interferon gamma, tumor nercrosis factor alpha, interleukin-6, and C-reactive protein levels. Parametric and non-parametric tests determined significant group differences in asymmetries and biomarkers, respectively. Spearman's correlations identified relationships between biomarkers and asymmetries with statistically significant group differences. FINDINGS Adolescents with obesity had greater sagittal (loading, midstance) and frontal (midstance, pre-swing) plane kinetic knee asymmetry and higher concentrations of interleukin-6 and C-reactive protein. A moderately negative correlation existed between C-reactive protein and sagittal (loading, midstance) plane asymmetry, and also between interleukin-6 and frontal (pre-swing) plane asymmetry. INTERPRETATION Inflammatory response increases with greater knee joint asymmetry, suggesting knee joint damage and altered joint loading co-exist in adolescents with obesity. Increased risk to joint health may exist in sub-phases where knee joints are improperly loaded.
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Affiliation(s)
- Sarah P Shultz
- Kinesiology Department, Seattle University, Seattle, WA, USA.
| | - Ashley N Buck
- Kinesiology Department, Seattle University, Seattle, WA, USA.
| | - Philip W Fink
- STAPS, Université Sorbonne Paris Nord, Bobigny, France; Institut de Biomécanique Humaine Georges Charpak, Arts et Métiers ParisTech, Paris, France.
| | - Stacey M Kung
- Sports Medicine Department, Sports Surgery Clinic, Dublin, Ireland.
| | - Mary J Ward
- Weill Cornell Medicine, Department of Pediatrics, New York, NY, USA.
| | - Zoltan Antal
- Weill Cornell Medicine, Department of Pediatrics, New York, NY, USA.
| | - Sherry I Backus
- Leon Root, MD Motion Analysis Laboratory, Rehabilitation Department, Hospital for Special Surgery (HSS), New York, NY, USA.
| | - Andrew P Kraszewski
- Leon Root, MD Motion Analysis Laboratory, Rehabilitation Department, Hospital for Special Surgery (HSS), New York, NY, USA.
| | - Howard J Hillstrom
- Leon Root, MD Motion Analysis Laboratory, Rehabilitation Department, Hospital for Special Surgery (HSS), New York, NY, USA.
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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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Tsiros MD, Vincent HK, Getchell N, Shultz SP. Helping Children with Obesity "Move Well" To Move More: An Applied Clinical Review. Curr Sports Med Rep 2021; 20:374-383. [PMID: 34234093 DOI: 10.1249/jsr.0000000000000861] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
ABSTRACT Children with obesity experience musculoskeletal pain and reduced physical function and well-being, which collectively impact their fitness, strength, motor skills, and even their ability to undertake simple tasks, like walking and climbing stairs. Disrupting obesity-related disability may be critical to increasing children's physical activity. Thus, barriers to movement should be considered by health practitioners to improve the efficacy of prescribed physical activity. This applied clinical review highlights key subjective and objective findings from a hypothetical case scenario, linking those findings to the research evidence, before exploring strategies to enhance movement and increase physical activity.
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Affiliation(s)
- Margarita D Tsiros
- Alliance for Research in Exercise, Nutrition and Activity, UniSA Allied Health and Human Performance, Adelaide, SA, AUSTRALIA
| | - Heather K Vincent
- Department of Orthopaedics and Rehabilitation, Division of Physical Medicine and Rehabilitation, University of Florida, Gainesville, FL
| | - Nancy Getchell
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark, DE
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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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Mudge AJ, Thilak S, Wojciechowski EA, Burns J, Paget SP. The impact of being overweight on the mobility, temporal-spatial and kinematic aspects of gait in children with cerebral palsy. Obes Res Clin Pract 2021; 15:138-144. [PMID: 33546995 DOI: 10.1016/j.orcp.2021.01.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 01/11/2021] [Accepted: 01/15/2021] [Indexed: 12/17/2022]
Abstract
AIM Obesity causes altered gait patterns in typically developing children, but its effect on gait in children with physical disabilities is largely unknown. This study explores associations between body mass index (BMI), functional mobility and gait in children with cerebral palsy (CP). METHOD An observational cross-sectional study was conducted using three-dimensional gait analysis data from 197 children with CP, Gross Motor Functional Classification System (GMFCS) levels I to III. BMI values were categorised using the Centres for Disease Control and Prevention (2000) BMI percentiles, which are specific to age and gender. Regression analyses, with GMFCS level as a covariate, explored associations between BMI category and temporal-spatial, kinematic and functional mobility variables. Analyses included children categorised as healthy weight and overweight/obese only (n = 174), with underweight children excluded (n = 23). RESULTS 131 children (mean age 10.5 years, SD 3) were categorised as healthy weight and 43 children (mean age 9.6 years, SD 2.5) as overweight or obese. BMI was not associated with most gait variables. Increased double support time, reduced hip extension and increased ankle dorsiflexion were observed in children that were overweight, but most differences were small and of uncertain clinical significance. A lower proportion of overweight children walked independently over 500 m. CONCLUSION We found little evidence that BMI has a substantial influence on gait patterns in children with CP but some to suggest it may affect long-distance mobility. Different research strategies are required to improve understanding of relationships between adiposity, strength and function, for effective targeting of interventions to improve mobility.
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Affiliation(s)
- Anita J Mudge
- Paediatric Gait Analysis Service of NSW, Sydney Children's Hospitals Network (Randwick and Westmead), Sydney, New South Wales, Australia.
| | - Sinu Thilak
- Department of Adolescent Medicine, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Elizabeth A Wojciechowski
- Paediatric Gait Analysis Service of NSW, Sydney Children's Hospitals Network (Randwick and Westmead), Sydney, New South Wales, Australia; University of Sydney School of Health Sciences, Faculty of Medicine & Children's Hospital at Westmead, Sydney, Australia
| | - Joshua Burns
- University of Sydney School of Health Sciences, Faculty of Medicine & Children's Hospital at Westmead, Sydney, Australia
| | - Simon P Paget
- Kids Rehab, The Children's Hospital at Westmead, Sydney, New South Wales, Australia; Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
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Feka K, Brusa J, Cannata R, Giustino V, Bianco A, Gjaka M, Iovane A, Palma A, Messina G. Is bodyweight affecting plantar pressure distribution in children?: An observational study. Medicine (Baltimore) 2020; 99:e21968. [PMID: 32899034 PMCID: PMC7478521 DOI: 10.1097/md.0000000000021968] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
The aim of this study is twofold: firstly, to investigate the plantar pressure distribution differences in children coming from 4 different weight categories and secondly to analyze the presence of sex-related plantar pressure distribution differences.Overall, 416 children, aged 7 to 12 years old were randomly selected from 6 different local schools, and voluntarily participated in the study. Two hundred twenty six of them were men, while 190 were women (mean age: 9.93 ± 1.02 years; height: 1.39 ± 0.8 m; body mass: 37.76 ± 10.34 kg; BMI: 19.24 ± 4.02 kg/m). Based on the body mass index (BMI) the sample was grouped in the following categories: underweight (UW); normal weight (NW); overweight (OW), and obese (OB). Besides, the plantar load distribution parameters (total plantar load distribution and load distribution in forefoot and rearfoot) were assessed employing freeMed Maxi; Sensor Medica device. Shapiro-Wilk test was used to test the data distribution. Between-groups comparisons were conducted using Mann-Whitney U test, or using Kruskal-Wallis test associated with pairwise comparisons.There were significant differences in load distribution between weight categories, with (OW) and (NW) being significantly different with (O), P = .03 and P = .04, respectively. No significant differences were found on load distribution on the rearfoot and forefoot between categories. The sex effect, particularly among boys, revealed a different pattern of load distribution among (O) compared with other categories. This effect was not detected among women. Different profile of load distribution on the rearfoot and forefoot between boys and girls was found, with girls bearing significantly more weight in the right rearfoot compared with boys (P = .001).It can be concluded that the weight status of the children can affect the plantar load distribution, with obese category being different from (NW) and (OW). Additionally, the sex plays a role when it comes to the load distribution in different regions of the foot. Moreover, since the young age, due to growth and development process, is accompanied with anatomical foot changes which might be affected from numerous factors, assessing plantar pressure distribution in young children results to be a quite complicated matter.
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Affiliation(s)
- Kaltrina Feka
- Ph.D. Program in Health Promotion and Cognitive Sciences
| | | | | | | | - Antonino Bianco
- Ph.D. Program in Health Promotion and Cognitive Sciences
- Department of Psychology, Educational Science and Human Movement, University of Palermo, Palermo, Italy
| | - Masar Gjaka
- University for Business and Technology College, Department of Sport and Movement Science, Lagja Kalabria, Prishtine, Kosovo
| | - Angelo Iovane
- Department of Psychology, Educational Science and Human Movement, University of Palermo, Palermo, Italy
| | - Antonio Palma
- Department of Psychology, Educational Science and Human Movement, University of Palermo, Palermo, Italy
| | - Giuseppe Messina
- PosturaLab Italia
- Department of Psychology, Educational Science and Human Movement, University of Palermo, Palermo, Italy
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Theis N, Le Warne M, Morrison SC, Drechsler W, Mahaffey R. Absolute and Allometrically Scaled Lower-Limb Strength Differences Between Children With Overweight/Obesity and Typical Weight Children. J Strength Cond Res 2019; 33:3276-3283. [DOI: 10.1519/jsc.0000000000003382] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Health‐related physical fitness and weight status in 13‐ to 15‐year‐old Latino adolescents. A pooled analysis. JORNAL DE PEDIATRIA (VERSÃO EM PORTUGUÊS) 2019. [DOI: 10.1016/j.jpedp.2018.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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García-Hermoso A, Correa-Bautista JE, Olloquequi J, Ramírez-Vélez R. Health-related physical fitness and weight status in 13- to 15-year-old Latino adolescents. A pooled analysis. J Pediatr (Rio J) 2019; 95:435-442. [PMID: 29738741 DOI: 10.1016/j.jped.2018.04.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Revised: 03/29/2018] [Accepted: 04/09/2018] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE The aim of this study was to investigate the relation between health-related physical fitness and weight status in 13- to 15-year-old Latino adolescents. METHOD The final sample consisted of 73,561 adolescents aged 13-15 years (35,175 girls) from Chile (n=48,771) and Colombia (n=24,790). Cardiorespiratory and musculoskeletal fitness were measured using 20-m shuttle run (relative peak oxygen uptake - VO2peak) and standing broad jump test (lower body explosive strength), respectively. The International Obesity Task Force definition was used to define weight status (i.e., underweight, normal weight, overweight, and obese). RESULTS The present study found an inverted J-shape relationship between body mass index, cardiorespiratory fitness, and musculoskeletal fitness in both genders and all age groups (p<0.01). Results also suggest that underweight adolescents, and not just overweight and obese adolescents, have lower odds of having a healthy cardiorespiratory fitness (based on new international criterion-referenced standards) profile when compared with their normal weight peers, except in girls aged 14 (p=0.268) and 15 years (p=0.280). CONCLUSIONS The present results indicate low cardiorespiratory fitness and musculoskeletal fitness levels in underweight, overweight, and obese adolescents when compared with their normal weight peers. The findings appear to suggest that exercise programs should to decrease fat mass in overweight/obese adolescents and increase muscle mass in underweight adolescents.
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Affiliation(s)
- Antonio García-Hermoso
- Universidad de Santiago de Chile (USACH), Facultad de Ciencias Médicas, Laboratorio de Ciencias de la Actividad Física, el Deporte y la Salud, Santiago, Chile.
| | - Jorge E Correa-Bautista
- Universidad del Rosario, Escuela de Medicina y Ciencias de la Salud, Centro de Estudios en Medición de la Actividad Física (CEMA), Bogotá, Colombia
| | - Jordi Olloquequi
- Universidad Autónoma de Chile, Facultad de Ciencias de la Salud, Talca, Chile
| | - Robinson Ramírez-Vélez
- Universidad del Rosario, Escuela de Medicina y Ciencias de la Salud, Centro de Estudios en Medición de la Actividad Física (CEMA), Bogotá, Colombia
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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: 51] [Impact Index Per Article: 10.2] [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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14
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Montes-Alguacil J, Páez-Moguer J, Jiménez Cebrián AM, Muñoz BÁ, Gijón-Noguerón G, Morales-Asencio JM. The influence of childhood obesity on spatio-temporal gait parameters. Gait Posture 2019; 71:69-73. [PMID: 31009919 DOI: 10.1016/j.gaitpost.2019.03.031] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Revised: 03/18/2019] [Accepted: 03/29/2019] [Indexed: 02/02/2023]
Abstract
UNLABELLED The musculoskeletal and neurosensorial development of children can be affected by excess body weight. Studies have examined how childhood obesity affects gait, but much about the influence of this factor remains to be determined. The aim of our study is to analyse, in a large sample of children, the influence of obesity on the spatiotemporal parameters of the gait cycle, in the most natural way possible, with the subjects walking overground at a self-selected speed. METHOD For this study, the sample was composed of 238 healthy school children, composed of 114 (47.9%) girls and 124 (52.1%) boys, aged 7-11 years. For each one, the body mass index was calculated, according to which the subjects were classified by percentiles as low weight, normal weight, overweight or obese. Anthropometric variables were measured and the spatiotemporal parameters of gait were assessed by the OptoGait® portable photocell system. RESULTS The spatial variables did not reveal significant differences between the children with normal weight and those with obesity. However, the differences for stance phase, load response and pre-swing phase (p = 0.0001, p = 0.016 and p = 0.0001, respectively) were clearly significant. CONCLUSIONS Childhood obesity exerts a significant influence on gait by increasing the duration of load response and that of the pre-swing towards the oscillation phase and therefore the total duration of the support phase. This outcome requires greater energy expenditure to stabilise the gait of children with obesity, and could have biomechanical repercussions.
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Affiliation(s)
| | | | | | | | - Gabriel Gijón-Noguerón
- Podiatry Department, Health Sciences Faculty, Instituto de Investigación Biomédica de Málaga (IBIMA), University of Malaga, Spain.
| | - José Miguel Morales-Asencio
- Podiatry Department, Health Sciences Faculty, Instituto de Investigación Biomédica de Málaga (IBIMA), University of Malaga, Spain.
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15
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Symmetry of Gait in Underweight, Normal and Overweight Children and Adolescents. SENSORS 2019; 19:s19092054. [PMID: 31052569 PMCID: PMC6539288 DOI: 10.3390/s19092054] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Revised: 04/24/2019] [Accepted: 04/30/2019] [Indexed: 12/22/2022]
Abstract
Abnormal excess or lack of body mass can influence gait patterns, but in some cases such differences are subtle and not easy to detect, even with quantitative techniques for movement analysis. In these situations, the study of trunk accelerations may represent an effective way to detecting gait anomalies in terms of symmetry through the calculation of Harmonic Ratio (HR), a parameter obtained by processing trunk accelerations in the frequency domain. In the present study we used this technique to assess the existence of differences in HR during gait in a cohort of 75 healthy children and early adolescents (aged 7-14 years) stratified into 3 equally-sized age and gender-matched groups (Underweight: UW; Normal Weight: NW; Overweight: OW). The accelerometric signal, acquired using a single wearable inertial sensor, was processed to calculate stride length, speed, cadence and HR in antero-posterior, vertical and medio-lateral directions. No differences in spatio-temporal parameters were found among groups, while the HR in the medio-lateral direction was found significantly lower in UW children, while OW exhibited the highest values. On the basis of the results obtained, HR appears capable of discriminating gait symmetry in children with different body mass even when conventional gait parameters are unchanged.
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16
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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: 27] [Impact Index Per Article: 4.5] [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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17
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Hainsworth KR, Liu XC, Simpson PM, Swartz AM, Linneman N, Tran ST, Medrano GR, Mascarenhas B, Zhang L, Weisman SJ. A Pilot Study of Iyengar Yoga for Pediatric Obesity: Effects on Gait and Emotional Functioning. CHILDREN-BASEL 2018; 5:children5070092. [PMID: 29973555 PMCID: PMC6068554 DOI: 10.3390/children5070092] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/29/2018] [Revised: 06/16/2018] [Accepted: 06/25/2018] [Indexed: 12/28/2022]
Abstract
Obesity negatively impacts the kinematics and kinetics of the lower extremities in children and adolescents. Although yoga has the potential to provide several distinct benefits for children with obesity, this is the first study to examine the benefits of yoga for gait (primary outcome) in youths with obesity. Secondary outcomes included health-related quality of life (HRQoL), physical activity, and pain. Feasibility and acceptability were also assessed. Nine youths (11⁻17 years) participated in an eight-week Iyengar yoga intervention (bi-weekly 1-h classes). Gait, HRQOL (self and parent-proxy reports), and physical activity were assessed at baseline and post-yoga. Pain was self-reported at the beginning of each class. Significant improvements were found in multiple gait parameters, including hip, knee, and ankle motion and moments. Self-reported and parent-proxy reports of emotional functioning significantly improved. Time spent in physical activity and weight did not change. This study demonstrates that a relatively brief, non-invasive Iyengar yoga intervention can result in improved malalignment of the lower extremities during ambulation, as well as in clinically meaningful improvements in emotional functioning. This study extends current evidence that supports a role for yoga in pediatric obesity.
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Affiliation(s)
- Keri R Hainsworth
- Jane B. Pettit Pain and Headache Center, Department of Anesthesiology and Children's Hospital of Wisconsin, Medical College of Wisconsin, Milwaukee, WI 53226, USA.
| | - Xue Cheng Liu
- Department of Orthopedics, Children's Hospital of Wisconsin, Medical College of Wisconsin, Milwaukee, WI 53226, USA.
| | - Pippa M Simpson
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI 53226, USA.
- Division of Quantitative Health Sciences, Medical College of Wisconsin, Milwaukee, WI 53226, USA.
| | - Ann M Swartz
- Department of Kinesiology, University of Wisconsin-Milwaukee, Milwaukee, WI 53211, USA.
| | - Nina Linneman
- Department of Educational Psychology, University of Wisconsin-Milwaukee, Milwaukee, WI 53211, USA.
| | - Susan T Tran
- Department of Psychology, DePaul University, Chicago, IL 60614, USA.
| | - Gustavo R Medrano
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL 60612, USA.
| | | | - Liyun Zhang
- Division of Quantitative Health Sciences, Medical College of Wisconsin, Milwaukee, WI 53226, USA.
| | - Steven J Weisman
- Jane B. Pettit Pain and Headache Center, Department of Anesthesiology and Children's Hospital of Wisconsin, Medical College of Wisconsin, Milwaukee, WI 53226, USA.
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18
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Effects of a Program for Improving Biomechanical Characteristics During Walking and Running in Children Who Are Obese. Pediatr Phys Ther 2017; 29:330-340. [PMID: 28953178 DOI: 10.1097/pep.0000000000000440] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
PURPOSE To investigate the influence of a weight-reduction program with locomotion-emphasis on improving biomechanical characteristics of children who are obese (OW). METHODS Ten children who are OW participated in a 6-month multidisciplinary childhood obesity management program (GRP1); another 10 children who are OW participated in the same multidisciplinary childhood obesity management program with additional locomotion-emphasis exercises for improving biomechanical characteristics (GRP2); and 10 control children who are OW with no intervention program. Outcomes were anthropometric measurements and temporal and foot pressure parameters. RESULTS GRP2 had significantly improved foot pressure in the different walking/running speeds compared with GRP1. In the temporal parameters, pretests by speed by group interactions were significantly improved for GRP2 compared with GRP1. CONCLUSIONS We found evidence to support beneficial effects of combined dietary and physical activity/locomotion-emphasis exercises on the movement characteristics of children who are OW.
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19
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Rubinstein M, Eliakim A, Steinberg N, Nemet D, Ayalon M, Zeev A, Pantanowitz M, Brosh T. Biomechanical characteristics of overweight and obese children during five different walking and running velocities. FOOTWEAR SCIENCE 2017. [DOI: 10.1080/19424280.2017.1363821] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Affiliation(s)
- Meron Rubinstein
- The Wingate College of Physical Education and Sport Sciences, Wingate Institute, Netanya, Israel
| | - Alon Eliakim
- Child Health and Sport Center, Pediatric Department, Meir Medical Center, Sackler School of Medicine, Tel Aviv University, Kfar-Saba, Israel
| | - Nili Steinberg
- The Wingate College of Physical Education and Sport Sciences, Wingate Institute, Netanya, Israel
| | - Dan Nemet
- Child Health and Sport Center, Pediatric Department, Meir Medical Center, Sackler School of Medicine, Tel Aviv University, Kfar-Saba, Israel
| | - Moshe Ayalon
- The Wingate College of Physical Education and Sport Sciences, Wingate Institute, Netanya, Israel
| | - Aviva Zeev
- The Wingate College of Physical Education and Sport Sciences, Wingate Institute, Netanya, Israel
| | - Michal Pantanowitz
- Child Health and Sport Center, Pediatric Department, Meir Medical Center, Sackler School of Medicine, Tel Aviv University, Kfar-Saba, Israel
| | - Tamar Brosh
- Department of Oral Biology, School of Dental Medicine, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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20
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Strutzenberger G, Alexander N, Bamboschek D, Claas E, Langhof H, Schwameder H. Uphill walking: Biomechanical demand on the lower extremities of obese adolescents. Gait Posture 2017; 54:20-26. [PMID: 28242569 DOI: 10.1016/j.gaitpost.2017.02.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Revised: 02/15/2017] [Accepted: 02/17/2017] [Indexed: 02/02/2023]
Abstract
The number of obesity prevalence in adolescents is still increasing. Obesity treatment programs typically include physical activity with walking being recommended as appropriate activity, but limited information exists on the demand uphill walking places on the joint loading and power of obese adolescents. Therefore, the purpose of this study was to investigate the effect of different inclinations on step characteristics, sagittal and frontal joint angles, joint moments and joint power of obese adolescents in comparison to their normal-weight peers. Eleven obese (14.5±1.41 years, BMI: 31.1±3.5kg/m2) and eleven normal-weight adolescents (14.3±1.86 years, BMI: 19.0±1.7kg/m2) walked with 1.11m/s on a ramp with two imbedded force plates (AMTI, 1000Hz) at three inclinations (level, 6°, 12°). Kinematic data were collected via an infrared-camera motion system (Vicon, 250Hz). The two-way (inclination, group) ANOVA indicated a significant effect of inclination on almost all variables analysed, with the hip joint being the most affected by inclination, followed by the knee and ankle joint. The obese participants additionally spent less time in swing phase, walked with an increased knee flexion and valgus angle and an increased peak hip flexion and adduction moment. Hip joint power of obese adolescents was especially in the steepest inclination significantly increased compared to their normal-weight peers. Obese adolescents demonstrate increased joint loading compared to their normal-weight peers and in combination with a musculoskeletal malalignment they might be prone to an increased overuse injury risk.
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Affiliation(s)
- Gerda Strutzenberger
- Department of Sport Science and Kinesiology, University of Salzburg, Salzburg, Austria.
| | - Nathalie Alexander
- Department of Sport Science and Kinesiology, University of Salzburg, Salzburg, Austria
| | - Dominik Bamboschek
- Department of Sport Science and Kinesiology, University of Salzburg, Salzburg, Austria
| | - Elisabeth Claas
- Department of Sport Science and Kinesiology, University of Salzburg, Salzburg, Austria; IBO, German Sport University Cologne, Germany
| | | | - Hermann Schwameder
- Department of Sport Science and Kinesiology, University of Salzburg, Salzburg, Austria
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21
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BARNES CLAIREM, CLARK CAINCT, HOLTON MARKD, STRATTON GARETH, SUMMERS HUWD. Quantitative Time Profiling of Children's Activity and Motion. Med Sci Sports Exerc 2017; 49:183-190. [DOI: 10.1249/mss.0000000000001085] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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22
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Clark CC, Barnes CM, Holton M, Summers HD, Stratton G. Profiling movement quality and gait characteristics according to body-mass index in children (9–11 y). Hum Mov Sci 2016; 49:291-300. [DOI: 10.1016/j.humov.2016.08.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Revised: 08/10/2016] [Accepted: 08/10/2016] [Indexed: 12/15/2022]
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23
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Beurskens R, Muehlbauer T, Grabow L, Kliegl R, Granacher U. Effects of Backpack Carriage on Dual-Task Performance in Children During Standing and Walking. J Mot Behav 2016; 48:500-508. [DOI: 10.1080/00222895.2016.1152137] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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