Do mechanical gait parameters explain the higher metabolic cost of walking in obese adolescents?

Similar maximal aerobic capacity but lower energy efficiency during low-to-moderate exercise in women with constitutional thinness: new results from the NUTRILEAN study

PURPOSE

Individuals with constitutional thinness have been presented with a lower muscular energy metabolism at the cellular level but their effective aerobic capacities and exercise-related energy efficiency remains unexplored. The present study compares maximal and sub-maximal aerobic capacities between subjects with constitutional thinness and age-matched normal-weight ones.

METHODS

Anthropometric measures, body composition (Dual-X-ray absorptiometry), physical activity and sedentary time (GT3x actigraphs), and maximal aerobic capacities (cyclingV ˙ O 2peak test) were assessed in 18 constitutionally thin (CT-body mass index < 17.5 kg m-2) and 17 normal-weight (NW-body mass index between 20 and 25 kg m-2) women. Energy efficiency was assessed during a submaximal cycling test and a walking exercise.

RESULTS

CT had a lower body mass and body mass index compared to NW. Absolute peak oxygen uptake and maximal aerobic power were lower in CT subjects compared to NW (ES: - 1.63 [- 2.40; - 0.86] and - 1.32 [- 2.05; - 0.58], p < 0.001).V ˙ O 2peak related to body mass was not different between groups. Gross and net efficiency (ES: - 0.78 [- 1.48; - 0.06], p = 0.03 and ES: - 0.73 [- 1.43; - 0.01], p = 0.05) were lower in CT compared to NW during the submaximal cycling exercise. The gross energy cost of walking related to body mass was lower in subjects with CT (ES: - 1.80 [- 2.60; - 0.97, p = 0.05), with no difference for the net one. Perceived exertion was similar between groups in responses to both submaximal exercises.

CONCLUSION

Constitutionally thin women do not show impaired aerobic capacities at moderate to maximal intensities despite lower energy efficiency while cycling and walking at low-to-moderate intensities.

Treadmill walking economy is not affected by body fat and body mass index in adults

To determine whether body fat and body mass index (BMI) affect the energy cost of walking (Cw; J/kg/m), ventilation, and gas exchange data from 205 adults (115 females; percent body fat range = 3.0%-52.8%; BMI range = 17.5-43.2 kg/m2) were obtained at rest and during treadmill walking at 1.34 m/s to calculate gross and net Cw. Linear regression was used to assess relationships between body composition indices, Cw, and standing metabolic rate (SMR). Unpaired t-tests were used to assess differences between sex, and one-way ANOVA was used to assess differences by BMI categories: normal weight, <25.0 kg/m2; overweight, 25.0-29.9 km/m2; and obese, ≥30 kg/m2. Net Cw was not related to body fat percent, fat mass, or BMI (all R2 ≤ 0.011). Furthermore, mean net Cw was similar by sex (male: 2.19 ± 0.30 J/kg/m; female: 2.24 ± 0.37 J/kg/m, p = 0.35) and across BMI categories (normal weight: 2.23 ± 0.36 J/kg/m; overweight: 2.18 ± 0.33 J/kg/m; obese: 2.26 ± 0.31, p = 0.54). Gross Cw and SMR were inversely associated with percent body fat, fat mass, and BMI (all R2 between 0.033 and 0.270; all p ≤ 0.008). In conclusion, Net Cw is not influenced by body fat percentage, total body fat, and BMI and does not differ by sex.

Faster stepping cadence partially explains the higher metabolic cost of walking among females versus males

The metabolic cost of walking (MCOW), or oxygen uptake normalized to distance, provides information on the energy expended during movement. There are conflicting reports as to whether sex differences in MCOW exist, with scarce evidence investigating factors that explain potential sex differences. This study 1) tested the hypothesis that females exhibit a higher MCOW than males, 2) determined whether normalizing to stepping cadence ameliorates the hypothesized sex difference, and 3) explored whether more habitual step counts and time in intensity-related physical activity, and less sedentary time were associated with a decreased MCOW. Seventy-six participants (42 females, 24 ± 5 yr) completed a five-stage, graded treadmill protocol with speeds increasing from 0.89 to 1.79 m/s (6-min walking stage followed by 4-min passive rest). Steady-state oxygen uptake (via indirect calorimetry) and stepping cadence (via manual counts) were determined. Gross and net MCOW, normalized to distance traveled (km) and step-cadence (1,000 steps) were calculated for each stage. Thirty-nine participants (23 females) wore an activPAL on their thigh for 6.9 ± 0.4 days. Normalized to distance, females had greater gross MCOW (J/kg/km) at all speeds (P < 0.014). Normalized to stepping frequency, females exhibited greater gross and net MCOW at 1.12 and 1.79 m/s (J/kg/1,000 steps; P < 0.01) but not at any other speeds (P < 0.075). Stature was negatively associated with free-living cadence (r = -0.347, P = 0.030). Females expend more energy/kilometer traveled than males, but normalizing to stepping cadence attenuated these differences. Such observations provide an explanation for prior work documenting higher MCOW among females and highlight the importance of stepping cadence when assessing the MCOW.NEW & NOTEWORTHY Whether there are sex differences in the metabolic cost of walking (MCOW) and the factors that may contribute to these are unclear. We demonstrate that females exhibit a larger net MCOW than males. These differences were largely attenuated when normalized to stepping cadence. Free-living activity was not associated with MCOW. We demonstrate that stepping cadence, but not free-living activity, partially explains the higher MCOW in females than males.

The influence of obesity and fat distribution on ankle muscle coactivation during gait

BACKGROUND

Excessive body weight is associated with gait alterations. In none of previous studies, body fat distribution has been considered as a factor that could change gait parameters and induce different neuromuscular adaptations.

OBJECTIVE

This multicenter, analytical, and cross-sectional study aimed to investigate the influence of the body mass distribution on gait parameters and ankle muscle coactivation in obese individuals.

METHODS

Three distinct groups were included in the study: a non-obese control group (CG, n = 15, average age = 32.8 ± 6.5 years, BMI = 21.4 ± 2.2 kg/m2), an obese-android group characterized by a Waist to Hip Ratio (WHR) greater than 1 (OAG, n = 15, age = 32.4 ± 3.9 years, BMI = 41.4 ± 3.9 kg/m2, WHR = 1.2 ± 0.2), and an obese-gynoid group with a WHR less than 1 (OGG, n = 15, age = 35.4 ± 4.1 years, BMI = 40.0 ± 5.7 kg/m2, WHR = 0.82 ± 0.3). All participants walked on an instrumented gait analysis treadmill at their self-selected walking speed for one minute. Spatiotemporal parameters, walking cycle phases, vertical ground reaction force (GRFv) and center of pressure (CoP) velocity were sampled from the treadmill software. Electromyography (EMG) activity of the gastrocnemius medialis (GM), the soleus (SOL) and tibialis anterior (TA) were collected during walking and used to calculate coactivation indexes (CI) between ankle plantar and dorsal flexors (GM/TA and SOL/TA) for the different walking cycle phases.

RESULTS

Compared to OAG, OGG walked with shorter and larger strides, lower CoP velocity and GRFv. During the single support phase, SOL/TA coactivation was higher in OAG compared to OGG (p < .05). During the propulsion phase, SOL/TA coactivation was higher in OGG compared to OAG (p < .05).

CONCLUSION

Gait parameters and ankle muscle coactivation in obese individuals seem to be strongly dependent on body mass distribution. From the biomechanical point of view, body mass distribution changes gait strategies in obese individuals inducing different neuromuscular adaptations during the single support and propulsion phases.

Improved walking energy efficiency might persist in presence of simulated full weight regain after multidisciplinary weight loss in adolescents with obesity: the POWELL study

AIM

Weight loss leads to a reduction of the energy cost of walking but the respective implications of the metabolic and mechanic changes remain unknown. The present study compares the post-weight loss energy cost of walking (Cw) with and without a total reload of the induced weight reduction in adolescents with obesity.

METHODS

Energy cost of walking and substrate use were evaluated during a graded walking exercise (4×6-min at 0.75, 1, 1.25, 1.5 m.s-1) before (V1) and after a 12-week intervention in 21 adolescents with obesity (11 girls; 13.8 ± 1.4 y). After weight loss, the walking exercise was randomly repeated once without weight reload (V2) and once with a loading corresponding to the total induced weight loss during the program (V2L). Body composition was assessed before and after the intervention.

RESULTS

Body weight and fat mass decreased in response to the 12-week intervention (p < 0.001), while FFM did not change. The absolute gross Cw (ml.m-1) was higher on V1 compared with V2 at every speed. The absolute net Cw (ml.m-1) was higher on V1 compared to V2L at 0.75 m.s-1 (p = 0.04) and 1 m.s-1 (p = 0.02) and higher on V2L compared with V2 at 1.5 m.s-1 (p = 0.03). Net Cw (ml.m-1.kg-1) on V1 being higher than V2 (p < 0.001), and V2L higher than V2 (p = 0.006). The absolute CHO oxidation (mg.min-1) did not show any condition effect (p = 0.12) while fat utilization was higher on V1 compared to V2 and V2L (p < 0.001). Relative to body weight CHO oxidation was lower on V1 compared to V2 (p = 0.04) and V2L (p = 0.004) while relative to body weight fat oxidation was higher on V1 than V2 (p = 0.002).

CONCLUSION

Adolescents with obesity might not show an entire rise back to pre-weight loss values of their metabolic cost of walking when weight gain is simulated. These new findings suggest metabolic and physiological adaptations to weight loss of the energy metabolism that remain to be clarified.

The impact of obesity on static and proactive balance and gait patterns in sarcopenic older adults: an analytical cross-sectional investigation

Background

Obesity is increasingly recognized as a significant factor in the susceptibility of older adults to falls and related injuries. While existing literature has established a connection between obesity and reduced postural stability during stationary stances, the direct implications of obesity on walking dynamics, particularly among the older adults with sarcopenia, are not yet comprehensively understood.

Objective

Firstly, to investigate the influence of obesity on steady-state and proactive balance, as well as gait characteristics, among older adults with sarcopenic obesity (SO); and secondly, to unearth correlations between anthropometric characteristics and balance and gait parameters in the same demographic.

Methods

A cohort of 42 participants was categorized into control (CG; n = 22; age = 81.1 ± 4.0 years; BMI = 24.9 ± 0.6 kg/m²) and sarcopenic obese (SOG; n = 20; age = 77.7 ± 2.9 years; BMI = 34.5 ± 3.2 kg/m²) groups based on body mass index (BMI, kg/m²). Participants were assessed for anthropometric data, body mass, fat and lean body mass percentages (%), and BMI. Steady-state balance was gauged using the Romberg Test (ROM). Proactive balance evaluations employed the Functional Reach (FRT) and Timed Up and Go (TUG) tests. The 10-m walking test elucidated spatiotemporal gait metrics, including cadence, speed, stride length, stride time, and specific bilateral spatiotemporal components (stance, swing, 1st and 2nd double support, and single support phases) expressed as percentages of the gait cycle.

Results

The time taken to complete the TUG and ROM tests was significantly shorter in the CG compared to the SOG (p < 0.05). In contrast, the FRT revealed a shorter distance achieved in the SOG compared to the CG (p < 0.05). The CG exhibited a higher gait speed compared to the SOG (p < 0.05), with shorter stride and step lengths observed in the SOG compared to the CG (p < 0.05). Regarding gait cycle phases, the support phase was longer, and the swing phase was shorter in the SOG compared to the CG group (p < 0.05). LBM (%) showed the strongest positive correlation with the ROM (r = 0.77, p < 0.001), gait speed (r = 0.85, p < 0.001), TUG (r = -0.80, p < 0.001) and FRT (r = 0.74, p < 0.001).

Conclusion

Obesity induces added complexities for older adults with sarcopenia, particularly during the regulation of steady-state and proactive balance and gait. The percentage of lean body mass has emerged as a crucial determinant, highlighting a significant impact of reduced muscle mass on the observed alterations in static postural control and gait among older adults with SO.

Pendular mechanism determinants and elastic energy usage during walking of obese and non-obese children

The mechanical and metabolic responses of walking by obese children are not yet well understood. The objectives of this study were (1) to compare the pendular mechanism (recovery, phase shift by α and β values, and ratio between forward and vertical mechanical work), the maximum possible elastic energy usage and the bilateral coordination during walking between non-obese and obese children, and (2) to verify if the bilateral coordination could contribute to understanding the pendular mechanism and elastic energy usage in these populations. Nine obese (six female, 8.7 ± 0.5 years, 1.38 ± 0.04 m, 44.4 ± 6.3 kg and 24.1 ± 3.50 kg/m2 ) and eight non-obese (four female, 7.4 ± 0.5 years, 1.31 ± 0.08 m, 26.6 ± 2.1 kg and 16.4 ± 1.40 kg/m2 ) children were analysed during walking on a treadmill at five speeds: 1, 2, 3, 4 and 5 km/h. The results indicated that although the mechanical energy response of the centre of mass during walking is similar between obese and non-obese children, the obese children showed a lower pendulum-like mechanism and greater elastic energy usage during level walking. Therefore, obese children seem to use more elastic energy during walking compared to non-obese children, which may be related to their apparent higher positive work production during the double support phase. Finally, bilateral coordination presented high values at slow speeds in both groups and requires further attention due to its association with falls. NEW FINDINGS: What is the central question of this study? Are there any differences of the pendular and elastic mechanisms and bilateral coordination during walking between non-obese and obese children? What is the main finding and its importance? To our knowledge, this study is the first to analyse the mechanical energy usage and the bilateral coordination of obese and non-obese children during walking. Obese children had a lower pendular recovery mechanism and used more elastic energy compared to non-obese children. The bilateral coordination was higher at slow speeds in both groups and requires further attention due to its association with falls.

Changes in dynamic balance control in adults with obesity across walking speeds

Adults with obesity have gait instability, leading to increased fall risks and decreased physical activity. Whole-body angular momentum (WBAM) is regulated over a gait cycle, essential to avoid a fall. However, how obese adults regulate WBAM during walking is unknown. The current study investigated changes in WBAM about the body's center of mass (COM) during walking in obese and non-obese adults across different walking speeds. Twenty-eight young adults with obesity and normal weight walked barefoot at a fixed walking speed (FWS, 1.25 m/s) and at five different speeds based on their preferred walking speed (PWS): 50, 75, 100, 125, and 150 % of PWS. Adults with obesity walked slower with shorter step length, wider step width, and longer double support time (p < 0.01). The ranges of frontal- and transverse-plane WBAM were greater in obese adults (p < 0.01). We also found that the range of frontal-plane WBAM did not significantly change with walking speed (p > 0.05), while the range of transverse-plane WBAM increased with walking speed (p < 0.01). The ranges of frontal- and transverse-plane WBAM increased with the mediolateral ground reaction force and mediolateral moment arm (p < 0.01), which may be most affected by lateral foot placement relative to the body's COM. Our findings suggest that controlling mediolateral stability during walking is more challenging in obese adults, independent of their slow walking speed. Understanding whole-body rotational dynamics observed in obese walking provides an insight into the biomechanical link between obesity and gait instability, which may help find a way to reduce fall risks and increase physical activity.

Effects of integrative neuromuscular training on the gait biomechanics of children with overweight and obesity

Objective

To analyze whether 13 weeks of integrative neuromuscular training can benefit spatiotemporal and kinematic parameters of gait in children with overweight/obesity.

Methods

This is a non‐randomized controlled trial. Fifty children (10.77 ± 1.24 years, 31 girls) with overweight/obesity were allocated to an exercise group (EG) (n = 25) that carried out a 13‐week exercise program based on fundamental movement skills, strength activities and aerobic training, and a control group (CG) (n = 25) that followed their normal lifestyle. Spatiotemporal (i.e., cadence, stance and support times, step length, and stride width) and kinematic (i.e., hip, pelvis, knee, and ankle angles) parameters were evaluated under laboratory conditions through a 3D analysis. ANCOVA was used to test raw and z‐score differences between the EG and CG at post‐exercise, adjusting for pre‐exercise values.

Results

The EG maintained their baseline stance and single‐limb support times while the CG increased them during walking (groups’ difference: 3.1 and 1.9 centiseconds). The EG maintained baseline maximum foot abduction angle during the stance phase whereas the CG showed an increase (groups’ difference: 3.9º). Additional analyses on kinematic profiles demonstrated that the EG walked with similar pelvic tilt and ankle abduction angles at post‐exercise, while the CG increased the pelvic anterior tilt in the whole stance phase (mean groups’ difference: 7.7º) and the ankle abduction angles in early‐ and mid‐stance phases (mean groups’ difference: 4.6º). No changes were observed in the rest of spatiotemporal and kinematic parameters.

Conclusions

The integrative neuromuscular training stopped the progression of some biomechanical alterations during walking in children with overweight/obesity. These findings could contribute to preventing common movement‐derived musculoskeletal disorders in this population, as well as preserving an optimal mechanical efficiency during walking.

The effect of obesity on whole-body angular momentum during steady-state walking

BACKGROUND

Individuals with obesity demonstrate deficits in postural stability, leading to increased fall risks. Controlling whole-body angular momentum is essential for maintaining postural stability during walking and preventing falls. However, it is unknown how obesity impacts whole-body angular momentum during walking.

RESEARCH PURPOSE

To investigate the change in angular momentum about the body's COM during walking in individuals with different degrees of obesity.

METHODS

Thirty-eight young adults with different body mass index (BMI) scores walked barefoot at their preferred speed on a treadmill for 2 min. The whole-body angular momentum has been quantified from ground reaction force and moment data to capture the rotational behavior of walking in individuals with obesity without relying solely on placing markers on anatomical landmarks.

RESULTS

We found that adults with higher BMI scores walked slower with shorter step length, wider step width, and longer double support time (ps<.01). Ranges of the frontal- and transverse-plane angular momentum were greater in adults with higher BMI scores (ps<.01), while no difference was observed between BMI groups in the total sum of changes in whole-body angular momentum in any plane (ps>.05).

SIGNIFICANCE

Obesity not only decreased walking speed but also limited the ability to control mediolateral stability during walking. Investigating how obesity affects whole-body angular momentum may help better understand why adults with obesity have atypical gait with poor balance, address fall risk factors, and facilitate participation in physical activities.

Fine Detection of Human Motion During Activities of Daily Living as a Clinical Indicator for the Detection and Early Treatment of Chronic Diseases: The E-Mob Project

Methods to measure physical activity and sedentary behaviors typically quantify the amount of time devoted to these activities. Among patients with chronic diseases, these methods can provide interesting behavioral information, but generally do not capture detailed body motion and fine movement behaviors. Fine detection of motion may provide additional information about functional decline that is of clinical interest in chronic diseases. This perspective paper highlights the need for more developed and sophisticated tools to better identify and track the decomposition, structuration, and sequencing of the daily movements of humans. The primary goal is to provide a reliable and useful clinical diagnostic and predictive indicator of the stage and evolution of chronic diseases, in order to prevent related comorbidities and complications among patients.

Effects of obesity and foot arch height on gait mechanics: A cross-sectional study

Foot arch structure contributes to lower-limb joint mechanics and gait in adults with obesity. However, it is not well-known if excessive weight and arch height together affect gait mechanics compared to the effects of excessive weight and arch height alone. The purpose of this study was to determine the influences of arch height and obesity on gait mechanics in adults. In this study, 1) dynamic plantar pressure, 2) spatiotemporal gait parameters, 3) foot progression angle, and 4) ankle and knee joint angles and moments were collected in adults with normal weight with normal arch heights (n = 11), normal weight with lower arch heights (n = 10), obesity with normal arch heights (n = 8), and obesity with lower arch heights (n = 18) as they walked at their preferred speed and at a pedestrian standard walking speed, 1.25 m/s. Digital foot pressure data were used to compute a measure of arch height, the Chippaux-Smirak Index (CSI). Our results revealed that BMI and arch height were each associated with particular measures of ankle and knee joint mechanics during walking in healthy young adults: (i) a higher BMI with greater peak internal ankle plantar-flexion moment and (ii) a lower arch height with greater peak internal ankle eversion and abduction moments and peak internal knee abduction moment (i.e., external knee adduction moment). Our results have implications for understanding the role of arch height in reducing musculoskeletal injury risks, improving gait, and increasing physical activity for people living with obesity.

Effect of very large body mass loss on energetics, mechanics and efficiency of walking in adults with obesity: mass-driven versus behavioural adaptations

Abstract

Understanding the mechanisms involved in the higher energy cost of walking (NC_w: the energy expenditure above resting per unit distance) in adults with obesity is pivotal to optimizing the use of walking in weight management programmes. Therefore, this study aimed to investigate the mechanics, energetics and mechanical efficiency of walking after a large body mass loss induced by bariatric surgery in individuals with obesity. Nine adults (39.5 ± 8.6 year; BMI: 42.7 ± 4.6 kg m^–2) walked at five fixed speeds before (baseline) and after the bariatric surgery (post 1 and post 2). Gas exchanges were measured to obtain NC_w. A motion analysis system and instrumented treadmill were combined to assess total mechanical work (W_tot). Mechanical efficiency (W_tot NC_w^–1) was also calculated. Participants lost 25.7 ± 3.4% of their body mass at post 1 (6.6 months; P < 0.001) and 6.1 ± 4.9% more at post 2 (12 months; P = 0.014). Mass‐normalized NC_w was similar between baseline and post 1 and decreased at post 2 compared to that at baseline (−6.2 ± 2.7%) and post 1 (−8.1 ± 1.9%; P ≤ 0.007). No difference was found in mass‐normalized W_tot during follow‐up (P = 0.36). Mechanical efficiency was similar at post 1 and post 2 when compared to that at baseline (P ≥ 0.19), but it was higher (+14.1 ± 4.6%) at post 2 than at post 1 (P = 0.013). These findings showed that after a very large body mass loss, individuals with obesity may reorganize their walking pattern into a gait more similar to that of lean adults, thus decreasing their NC_w by making their muscles work more efficiently.

Key points

A higher net (above resting) energy cost of walking (lower gait economy) is observed in adults with obesity compared to lean individuals.

Understanding the mechanisms (i.e. mass driven, gait pattern and behavioural changes) involved in this extra cost of walking in adults with obesity is pivotal to optimizing the use of walking to promote daily physical activity and improve health in these individuals.

We found that very large weight loss induced by bariatric surgery significantly decreased the energy cost of walking per kg of body mass after 1 year with similar total mechanical work per kg of body mass, resulting in an increased mechanical efficiency of walking.

Individuals with obesity may reorganize their walking pattern into a gait more similar to that of adults of normal body mass, thus decreasing their energy cost of walking by making their muscles work more efficiently.

Economical and preferred walking speed using body weight support apparatus with a spring-like characteristics

BACKGROUND

A specific walking speed minimizing the U-shaped relationship between energy cost of transport per unit distance (CoT) and speed is called economical speed (ES). To investigate the effects of reduced body weight on the ES, we installed a body weight support (BWS) apparatus with a spring-like characteristics. We also examined whether the 'calculated' ES was equivalent to the 'preferred' walking speed (PWS) with 30% BWS.

METHODS

We measured oxygen uptake and carbon dioxide output to calculate CoT values at seven treadmill walking speeds (0.67-2.00 m s^- 1) in 40 healthy young males under normal walking (NW) and BWS. The PWS was determined under both conditions on a different day.

RESULTS

A spring-like behavior of our BWS apparatus reduced the CoT values at 1.56, 1.78, and 2.00 m s^- 1. The ES with BWS (1.61 ± 0.11 m s^- 1) was faster than NW condition (1.39 ± 0.06 m s^- 1). A Bland-Altman analysis indicated that there were no systematic biases between ES and PWS in both conditions.

CONCLUSIONS

The use of BWS apparatus with a spring-like behavior reduced the CoT values at faster walking speeds, resulting in the faster ES with 30% BWS compared to NW. Since the ES was equivalent to the PWS in both conditions, the PWS could be mainly determined by the metabolic minimization in healthy young males. This result also derives that the PWS can be a substitutable index of the individual ES in these populations.

Mechanical work as a (key) determinant of energy cost in human locomotion: recent findings and future directions

NEW FINDINGS

What is the topic of this review? This narrative review explores past and recent findings on the mechanical determinants of energy cost during human locomotion, obtained by using a mechanical approach based on König's theorem (Fenn's approach). What advances does it highlight? Developments in analytical methods and their applications allow a better understanding of the mechanical-bioenergetic interaction. Recent advances include the determination of 'frictional' internal work; the association between tendon work and apparent efficiency; a better understanding of the role of energy recovery and internal work in pathological gait (amputees, stroke and obesity); and a comprehensive analysis of human locomotion in (simulated) low gravity conditions.

ABSTRACT

During locomotion, muscles use metabolic energy to produce mechanical work (in a more or less efficient way), and energetics and mechanics can be considered as two sides of the same coin, the latter being investigated to understand the former. A mechanical approach based on König's theorem (Fenn's approach) has proved to be a useful tool to elucidate the determinants of the energy cost of locomotion (e.g., the pendulum-like model of walking and the bouncing model of running) and has resulted in many advances in this field. During the past 60 years, this approach has been refined and applied to explore the determinants of energy cost and efficiency in a variety of conditions (e.g., low gravity, unsteady speed). This narrative review aims to summarize current knowledge of the role that mechanical work has played in our understanding of energy cost to date, and to underline how recent developments in analytical methods and their applications in specific locomotion modalities (on a gradient, at low gravity and in unsteady conditions) and in pathological gaits (asymmetric gait pathologies, obese subjects and in the elderly) could continue to push this understanding further. The recent in vivo quantification of new aspects that should be included in the assessment of mechanical work (e.g., frictional internal work and elastic contribution) deserves future research that would improve our knowledge of the mechanical-bioenergetic interaction during human locomotion, as well as in sport science and space exploration.

Interactions among obesity and age-related effects on the gait pattern and muscle activity across the ankle joint

OBJECTIVE

The purposes of this study were to investigate the combined effects of age and obesity on gait and to analyze the relationship between age and obesity on ankle muscle activities during walking.

MATERIALS AND METHODS

4 groups; the young non-obese control group (CG, n = 50, age = 31.8 ± 4.5 years; BMI = 21.4 ± 2.2 kg/m²), the young obese group (OB, n = 30, age = 35.4 ± 4.1 years; BMI = 38.6 ± 3.5 kg/m²), the non-obese older adults group (OA, n = 20, age = 76.1 ± 3.5 years; BMI = 24.4 ± 1.1 kg/m²) and the obese older adults group (OBOA, n = 20, age = 79.6 ± 5.7 years; BMI = 35.5 ± 2.7 kg/m²) walked on an instrumented gait analysis treadmill at their preferred walking speed. Spatiotemporal parameters, walking cycle phases, Vertical ground reaction force (GRFv) and center of pressure (CoP) velocity were sampled from the treadmill software. Electromyography (EMG) activity of the gastrocnemius medialis (GM), the soleus (SOL) and tibialis anterior (TA) were also collected during the walking test. A forward stepwise multiple regression analysis was performed to determine if body weight or age could predict ankle muscle activities during the different walking cycle phases.

RESULTS

Compared to OB, OBOA walked with higher CoP velocity, shorter stride, spending more time in support phase (p < .05). These manifestations were associated with higher TA and SOL activities during the 1st double support (1st DS) and higher TA activity during the single support (SS) (p < .05). Compared to OA, OBOA walked with lower GRFv, shorter and wider stride and spend more time in SU (p < .05). Moreover, SOL, TA and GM activities of OBOA were higher compared to OAG during 1st DS, SS and 2nd Double support (2nd DS), respectively (p < .05). During the 1ST DS, the stepwise multiple regression revealed that age accounted for 87% of the variance of TA activity. The addition of age contributed a further 16% to explain the variance TA activity. During the SS, age accounted for 64% and 46% of the variance of SOL and TA activity respectively. The addition of the body weight added further 15% and 66% of the variation of SOL and TA activity respectively. During the 2nd DS, body weight accounted for 86% of the variance and the addition of the body weight added a further 17% to explain the high level of GM.

CONCLUSION

Age in obese adults and obesity in older adults should be considered separately to evaluate neuromuscular responses during walking and, subsequently, optimize the modality of treatment and rehabilitation processes in obese individuals in order to reduce and/or prevent the risk of falls.

Mass-normalized internal mechanical work in walking is not impaired in adults with class III obesity

It has been suggested that internal mechanical work (i.e., the work required to move the limbs with respect to the center of mass, Wint) may be responsible for the higher net cost of walking in obese adults, but this variable has not yet been studied in individuals with obesity. The main finding of the present study is that individuals with class III obesity exhibit a similar amount of mass-normalized Wint to that of adults with a normal body weight, suggesting that body mass-relative Wint is not affected by obesity and is not responsible for the higher energy cost and the lower efficiency of walking in this population.

Respiratory responses and rating of perceived exertion of severely obese adolescents during continuous and intermittent graded walking protocols: Application to cardiorespiratory field tests

During 20 m shuttle tests, obese adolescents may have difficulty achieving maximum cardiorespiratory performance due to the presence of braking-relaunch phases (BRP). Nineteen obese adolescents aged 15.2 ± 1.5 years (body mass index [BMI] = 39.7 ± 5.9 kg.m^-2) performed three graded walking exercises on a 50 m track at speeds between 3 and 6 km/h: a continuous-straight-line protocol (C), a continuous protocol that required turning back every 30 sec (C-BRP) and an intermittent protocol that consisted of successively walking then resting for 15 sec (15-15). Oxygen uptake (VO₂), aerobic cost of walking (Cw), ventilation (VE) and rating of perceived exertion (RPE) were measured at each stage during the protocols. During C-BRP, the responses were not significantly higher compared with C (p > 0.30). During 15-15, the VO₂, Cw and VE were ~ 15 to 25% lower than during C beginning at 4 km/h (p < 0.05). In obese adolescents, the respiratory impact of sudden directional changes during the 20 m shuttle-type test appeared to be minor at walking speeds. During the 15-15 test, the intensity increases more progressively, and this design may encourage obese adolescents to walk further than during a continuous test.

Contributions of metabolic and temporal costs to human gait selection

Humans naturally select several parameters within a gait that correspond with minimizing metabolic cost. Much less is understood about the role of metabolic cost in selecting between gaits. Here, we asked participants to decide between walking or running out and back to different gait specific markers. The distance of the walking marker was adjusted after each decision to identify relative distances where individuals switched gait preferences. We found that neither minimizing solely metabolic energy nor minimizing solely movement time could predict how the group decided between gaits. Of our twenty participants, six behaved in a way that tended towards minimizing metabolic energy, while eight favoured strategies that tended more towards minimizing movement time. The remaining six participants could not be explained by minimizing a single cost. We provide evidence that humans consider not just a single movement cost, but instead a weighted combination of these conflicting costs with their relative contributions varying across participants. Individuals who placed a higher relative value on time ran faster than individuals who placed a higher relative value on metabolic energy. Sensitivity to temporal costs also explained variability in an individual's preferred velocity as a function of increasing running distance. Interestingly, these differences in velocity both within and across participants were absent in walking, possibly due to a steeper metabolic cost of transport curve. We conclude that metabolic cost plays an essential, but not exclusive role in gait decisions.

Influence of excess weight on lower-extremity vertical stiffness and metabolic cost of walking

The purpose was to test whether lower-extremity vertical stiffness and gait mechanics explain differences in energy cost of walking (Cw) between individuals with normal weight (NW) and obesity (OB). Ten OB (33.1 ± 2.0 kg m^-2) and 10 NW (24.2 ± 1.3 kg m^-2) walked for six minutes on an instrumented treadmill at 1.25 m s^-1 while Cw, lower-extremity kinematics, and vertical stiffness (K _vert) were measured. NW completed another trial with a loaded vest (NWL) to simulate the BMI of the obese group. Cw was 24% greater in OB (277.5 ± 45.3 J m^-1) and 23% greater in NWL (272.7 ± 35.7 J m^-1) than NW (211.0 ± 27.0 J m^-1, P < 0.005). Mass-specific Cw (Cw_kg) wasn't different between conditions (P = 0.085). Lower-extremity K _vert was 40% higher in OB (32.7 ± 5.2 kN m^-1) than NW (23.3 ± 4.7 kN m^-1, P < 0.001), but neither was different from NWL (27.5 ± 3.4 kN m^-1, P > 0.05). Mass-specific K _vert (P = 0.081) was similar across conditions. K _vert was related to Cw (r = 0.55, P = 0.001). Cw_kg wasn't different between NW or OB, but there was a negative correlation between BMI and Cw_kg driven by lower Cw_kg in NWL. Cw and K _vert covaried in proportion to body mass, but mass-specific K _vert was unrelated to Cw_kg. Mass-specific K _vert was lower in NWL than OB due to NWL's greater angle of attack, center of mass displacement, and joint range of motion.

A systematic review on biomechanical characteristics of walking in children and adolescents with overweight/obesity: Possible implications for the development of musculoskeletal disorders

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.

Energy-saving walking mechanisms in obese adults

Energy-saving mechanisms are used in human walking. In obese adults the energy cost of walking (Cw) is higher compared with normal-body mass adults. However, the biomechanical factors involved in this extra cost should result in a higher Cw. The aim of this study was to compare energy-saving walking mechanisms [i.e., mechanical energy saved via pendulum (Recovery) and maximum possible elastic energy usage (MPEEu)] and their influence on Cw in obese vs. lean individuals. The net Cw (NetCw), external work (Wext), Recovery, MPEEu, and gait weight transfer duration (gWT) were computed for 13 lean [L; body mass index (BMI) 21.9 ± 1.5 kg/m2] and 13 obese (O; BMI 33.8 ± 2.5 kg/m2) individuals during treadmill walking at five speeds (0.56, 0.83, 1.11, 1.39, 1.67 m/s). No significant difference was found between groups in relative (per kg of body mass) NetCw ( P = 0.13). Relative positive Wext was significantly lower at the three fastest speeds ( P ≤ 0.003) whereas Recovery was higher at the two fastest speeds ( P ≤ 0.01) in O than in L individuals. MPEEu tended to be lower in O than in L ( P = 0.06), with significantly lower values in O compared with L at 1.39 and 1.67 m/s ( P ≤ 0.017). gWT was significantly shorter in O than in L individuals at 1.67 m/s ( P = 0.001). The present results reveal that obese adults rely more on the pendular mechanism than on the storage and release of elastic energy for decreasing the amount of positive Wext and thus limiting the increase in the relative NetCw.

NEW & NOTEWORTHY We observed that obese individuals had a lower maximum possible elastic energy usage per kilogram of body mass than their lean counterparts and they may rely more on the pendular mechanism of walking than on the storage and release of elastic energy for decreasing the external mechanical work and thus limiting the increase in the relative net energy cost of walking.

Progressive changes in walking kinematics throughout pregnancy-A follow up study

BACKGROUND

Progressive weight gain and changes in its distribution following pregnancy may be challenging for the gravidas' ability to move in a stable way.

RESEARCH QUESTION

How is gait kinematics changing throughout pregnancy and to what extend is it affected by physical activity level and energy balance?

METHODS

30 women were enrolled. Three experimental sessions were arranged according to the same protocol in the first, second and third trimesters of pregnancy. Walking kinematics at a self-selected speed was registered. The total physical activity (TPA) was assessed from the subjects' questionnaires. Energy balance ('positive', 'balanced' or 'negative') was estimated as the difference between dietary energy intake and energy expenditure during 7 days.

RESULTS

No significant differences were found in the spatiotemporal variables between experimental sessions. However, the gait analysis revealed significant increments in the single support and base of support (BoS) measures. Generally, the sagittal plane mobility of the lower limb joints did not differ, however, the pelvic tilt increased in late pregnancy. The hip and pelvis angles were significantly different over the gait cycle throughout gestation. The 'balanced' energy was dominant in the first trimester although the relative number of participants with negative balance increased over pregnancy. Overall, gait parameters were independent of the energy balance. However, significant correlation was found between gait parameters, such as BoS, velocity, stride length, and TPA in the advanced pregnancy.

SIGNIFICANCE

The longitudinal assessment of walking kinematics demonstrates few changes adopted to accommodate for pregnancy. The enlargement of BoS is considered as a strategy to provide safety and stability. The increased pelvic tilt is likely to compensate for changes in the body mass distribution. The physical activity correlates with the BoS measures and stride length and thus may be important for enhancing gait stability.

Gait Pattern, Impact to the Skeleton and Postural Balance in Overweight and Obese Children: A Review

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.

No Differences in Energy Cost of a Predetermined Exercise among Young Overweight/Obese and Undernourished Individuals

Background:

Physical activity is an integral part of one's daily life. Obese (Ob) and undernourished (UN) persons are known to underperform physically as compared to normal weight (N) individuals. In this study, we have measured the energy spent to perform a prefixed exercise on treadmill walking and basal heart rate and blood pressure. Body mass index (BMI) and body fat of participating individuals were assessed. Fasting blood sugar and lipid profile were also evaluated.

Materials and Methods:

Eighty-three young individuals (male: 41; female: 42) of medical faculty, Universiti Sultan Zainal Abidin, who volunteered for the study, were recruited. The mean age of the individuals was 19.8 ± 0 years (P < 1.08). The individuals were grouped as N, UN/underweight, and overweight (Ow)/Ob based on BMI.

Results:

The results of the study revealed that there were no differences in the energy spent on performing the predetermined treadmill walking of 20 min duration among the three groups (a mean of 78 and 70 calories in all male and female subgroups, respectively). The distance covered by the males was 1.6 km while the females covered 1.4 km on treadmill walking in 20 min time. Basal blood pressure and heart rate and fasting blood sugar did not reveal any significant difference among the groups. However, total cholesterol and triglyceride levels were marginally higher in the Ow/Ob groups of male and female individuals as compared to other groups.

Conclusion:

Since the study individuals were very young and competitive by nature and possibly had no major metabolic disturbances, the differences in physical activity performances were not obvious. Possibly, such differences would become apparent only at later stages of life as age advances or when the intensity and duration of exercise are set at higher levels.

The Oxygen Consumption and Metabolic Cost of Walking and Running in Adults With Achondroplasia

The disproportionate body mass and leg length of Achondroplasic individuals may affect their net oxygen consumption (V͘O₂) and metabolic cost (C) when walking at running compared to those of average stature (controls). The aim of this study was to measure submaximal V͘O₂ and C during a range of set walking speeds (SWS; 0.56 – 1.94 m⋅s^-1, increment 0.28 m⋅s^-1), set running speeds (SRS; 1.67 – 3.33 m⋅s^-1, increment 0.28 m⋅s^-1) and a self-selected walking speed (SSW). V͘O₂ and C was scaled to total body mass (TBM) and fat free mass (FFM) while gait speed was scaled to leg length using Froude’s number (Fr). Achondroplasic V͘O_2TBM and V͘O_2FFM were on average 29 and 35% greater during SWS (P < 0.05) and 12 and 18% higher during SRS (P < 0.05) than controls, respectively. Achondroplasic C_TBM and C_FFM were 29 and 33% greater during SWS (P < 0.05) and 12 and 18% greater during SRS (P < 0.05) than controls, respectively. There was no difference in SSW V͘O_2TBM or V͘O_2FFM between groups (P > 0.05), but C_TBM and C_FFM at SSW were 23 and 29% higher (P < 0.05) in the Achondroplasic group compared to controls, respectively. V͘O_2TBM and V͘O_2FFM correlated with Fr for both groups (r = 0.984 – 0.999, P < 0.05). Leg length accounted for the majority of the higher V͘O_2TBM and V͘O_2FFM in the Achondroplasic group, but further work is required to explain the higher Achondroplasic C_TBM and C_FFM at all speeds compared to controls.

New and Noteworthy: There is a leftward shift of oxygen consumption scaled to total body mass and fat free mass in Achondroplasic adults when walking and running. This is nullified when talking into account leg length. However, despite these scalars, Achondroplasic individuals have a higher walking and metabolic cost compared to age matched non-Achondroplasic individuals, suggesting biomechanical differences between the groups.

An Inertial Sensor-Based Method for Estimating the Athlete's Relative Joint Center Positions and Center of Mass Kinematics in Alpine Ski Racing

For the purpose of gaining a deeper understanding of the relationship between external training load and health in competitive alpine skiing, an accurate and precise estimation of the athlete's kinematics is an essential methodological prerequisite. This study proposes an inertial sensor-based method to estimate the athlete's relative joint center positions and center of mass (CoM) kinematics in alpine skiing. Eleven inertial sensors were fixed to the lower and upper limbs, trunk, and head. The relative positions of the ankle, knee, hip, shoulder, elbow, and wrist joint centers, as well as the athlete's CoM kinematics were validated against a marker-based optoelectronic motion capture system during indoor carpet skiing. For all joints centers analyzed, position accuracy (mean error) was below 110 mm and precision (error standard deviation) was below 30 mm. CoM position accuracy and precision were 25.7 and 6.7 mm, respectively. Both the accuracy and precision of the system to estimate the distance between the ankle of the outside leg and CoM (measure quantifying the skier's overall vertical motion) were found to be below 11 mm. Some poorer accuracy and precision values (below 77 mm) were observed for the athlete's fore-aft position (i.e., the projection of the outer ankle-CoM vector onto the line corresponding to the projection of ski's longitudinal axis on the snow surface). In addition, the system was found to be sensitive enough to distinguish between different types of turns (wide/narrow). Thus, the method proposed in this paper may also provide a useful, pervasive way to monitor and control adverse external loading patterns that occur during regular on-snow training. Moreover, as demonstrated earlier, such an approach might have a certain potential to quantify competition time, movement repetitions and/or the accelerations acting on the different segments of the human body. However, prior to getting feasible for applications in daily training, future studies should primarily focus on a simplification of the sensor setup, as well as a fusion with global navigation satellite systems (i.e., the estimation of the absolute joint and CoM positions).

Being fat and smart: A comparative analysis of the fat-brain trade-off in mammals

Humans stand out among non-aquatic mammals by having both an extremely large brain and a relatively large amount of body fat. To understand the evolution of this human peculiarity we report a phylogenetic comparative study of 120 mammalian species, including 30 primates, using seasonal variation in adult body mass as a proxy of the tendency to store fat. Species that rely on storing fat to survive lean periods are expected to be less active because of higher costs of locomotion and have increased predation risk due to reduced agility. Because a fat-storage strategy reduces the net cognitive benefit of a large brain without reducing its cost, such species should be less likely to evolve a larger brain than non-fat-storing species. We therefore predict that the two strategies to buffer food shortages (storing body fat and cognitive flexibility) are compensatory, and therefore predict negative co-evolution between relative brain size and seasonal variation in body mass. This trade-off is expected to be stronger in predominantly arboreal species than in more terrestrial ones, as the cost of transporting additional adipose depots is higher for climbing than for horizontal locomotion. We did, indeed, find a significant negative correlation between brain size and coefficient of variation (CV) in body mass in both sexes for the subsample of arboreal species, both in all mammals and within primates. In predominantly terrestrial species, in contrast, this correlation was not significant. We therefore suggest that the adoption of habitually terrestrial locomotor habits, accompanied by a reduced reliance on climbing, has allowed for a primate of our body size the unique human combination of unusually large brains and unusually large adipose depots.

Getting fat or getting help? How female mammals cope with energetic constraints on reproduction

BACKGROUND

Fat deposits enable a female mammal to bear the energy costs of offspring production and thus greatly influence her reproductive success. However, increasing locomotor costs and reduced agility counterbalance the fitness benefits of storing body fat. In species where costs of reproduction are distributed over other individuals such as fathers or non-breeding group members, reproductive females might therefore benefit from storing less energy in the form of body fat.

RESULTS

Using a phylogenetic comparative approach on a sample of 87 mammalian species, and controlling for possible confounding variables, we found that reproductive females of species with allomaternal care exhibit reduced annual variation in body mass (estimated as CV body mass), which is a good proxy for the tendency to store body fat. Differential analyses of care behaviours such as allonursing or provisioning corroborated an energetic interpretation of this finding. The presumably most energy-intensive form of allomaternal care, provisioning of the young, had the strongest effect on CV body mass. In contrast, allonursing, which involves no additional influx of energy but distributes maternal help across different mothers, was not correlated with CV body mass.

CONCLUSIONS

Our results suggest that reproducing females in species with allomaternal care can afford to reduce reliance on fat reserves because of the helpers' energetic contribution towards offspring rearing.

Plantarflexor passive-elastic properties related to BMI and walking performance in older women

The objective of this study was to examine the influence of BMI on the passive-elastic properties of the ankle plantarflexors in older women. Twenty-three women, 65-80 yr, were separated into normal weight (NW, BMI <25.0kgm-2, n=11) and overweight-obese (OW, BMI≥25.0kgm-2, n=12) groups. Resistive torque of the ankle plantarflexors was recorded on an isokinetic dynamometer by passively moving the ankle into dorsiflexion. Stiffness, work absorption, and hysteresis were calculated across an ankle dorsiflexion angle of 10-15°. Maximal plantarflexor strength was assessed, then participants walked at maximal speed on an instrumented gait analysis treadmill while muscle activation (EMG) was recorded. Plantarflexor stiffness was 34% lower in OW (26.4±12.7Nmrad-1) than NW (40.0±15.7Nmrad-1, p=0.032). Neither work absorption nor hysteresis were different between OW and NW. Stiffness per kg was positively correlated to strength (r=0.66, p<0.001), peak vertical ground reaction force during walking (r=0.72, p<0.001), weight acceptance rate of force (r=0.51, p=0.007), push-off rate of force (r=0.41, p=0.026), maximal speed (r=0.61, p=0.001), and inversely correlated to BMI (r=-0.61, p=0.001), and peak plantarflexor EMG (r=-0.40, p=0.046). Older women who are OW have low plantarflexor stiffness, which may limit propulsive forces during walking and necessitate greater muscle activation for active force generation.

External Mechanical Work and Pendular Energy Transduction of Overground and Treadmill Walking in Adolescents with Unilateral Cerebral Palsy

PURPOSE

Motor impairments affect functional abilities and gait in children and adolescents with cerebral palsy (CP). Improving their walking is an essential objective of treatment, and the use of a treadmill for gait analysis and training could offer several advantages in adolescents with CP. However, there is a controversy regarding the similarity between treadmill and overground walking both for gait analysis and training in children and adolescents. The aim of this study was to compare the external mechanical work and pendular energy transduction of these two types of gait modalities at standard and preferred walking speeds in adolescents with unilateral cerebral palsy (UCP) and typically developing (TD) adolescents matched on age, height and body mass.

METHODS

Spatiotemporal parameters, external mechanical work and pendular energy transduction of walking were computed using two inertial sensors equipped with a triaxial accelerometer and gyroscope and compared in 10 UCP (14.2 ± 1.7 year) and 10 TD (14.1 ± 1.9 year) adolescents during treadmill and overground walking at standard and preferred speeds.

RESULTS

The treadmill induced almost identical mechanical changes to overground walking in TD adolescents and those with UCP, with the exception of potential and kinetic vertical and lateral mechanical works, which are both significantly increased in the overground-treadmill transition only in UCP (P < 0.05).

CONCLUSIONS

Adolescents with UCP have a reduced adaptive capacity in absorbing and decelerating the speed created by a treadmill (i.e., dynamic stability) compared to TD adolescents. This may have an important implication in rehabilitation programs that assess and train gait by using a treadmill in adolescents with UCP.

Lean adolescents achieve higher intensities but not higher energy expenditure while playing active video games compared with obese ones

BACKGROUND

While decreased physical activity and increased sedentary behaviours are incriminated for their role in the progression of obesity, active video games (AVG) may offer a new alternative to increase energy expenditure in youth. This study is the first to examine the effect of a 1-h AVG play on lean and obese adolescents' energy expenditure.

METHODS

Body composition and aerobic fitness were assessed in 19 obese and 12 lean adolescent boys (12-15 years old). Participants performed a 1-h AVG session (Kinect Sports technology) while wearing a portable indirect calorimeter (K4b2) to assess their energy expenditure and heart rate.

RESULTS

Body weight (91.0 ± 9.5 vs. 58.5 ± 12.4 kg), body mass index (32.2 ± 3.1 vs. 20.3 ± 1.6 kg m(-2) ) and body fat (38.1 ± 2.7 vs. 13.4 ± 3.9%) were significantly higher in obese adolescents (P < 0.001). Absolute energy expenditure was significantly higher in obese (P < 0.05) but not when corrected for body composition. Maximal heart rate reached during AVG was significantly higher in lean adolescents (190 ± 25 vs. 183 ± 28 bpm, P < 0.05). Time spent between 3 and 6 METs (Metabolic Equivalent Task) was not different between groups but time spent above 6 METs was higher in lean adolescents (P < 0.05).

CONCLUSION

Although lean and obese adolescent boys experienced similar energy expenditure relative to their body size during a 1-h Kinect AVG session, lean adolescents spent more time in moderate-to-vigorous physical activity.

Excess body weight and gait influence energy cost of walking in older adults

PURPOSE

The objective of this investigation is to study how excess body weight influences the energy cost of walking (Cw) and determine whether overweight and obese older adults self-select stride frequency to minimize Cw.

METHODS

Using body mass index (BMI), men and women between the ages of 65 and 80 yr were separated into normal weight (NW, BMI ≤24.9 kg·m(-2), n = 13) and overweight-obese groups (OWOB, BMI ≥25.0 kg·m(-2), n = 13). Subjects walked at 0.83 m·s on an instrumented treadmill that recorded gait parameters and completed three 6-min walking trials; at a preferred stride frequency (PSF), at +10% PSF, and at -10% PSF. Cw was determined by indirect calorimetry. Repeated-measures ANOVA was used to compare groups, and associations were tested with Pearson correlations, α = 0.05.

RESULTS

OWOB had 62% greater absolute Cw (301 ± 108 vs 186 ± 104 J·m, P < 0.001) and 20% greater relative Cw(kg) (3.48 ± 0.95 vs 2.91 ± 0.94 J·kg(-1)·m(-1), P = 0.046) than NW. Although PSF was not different between OWOB and NW (P = 0.626), Cw was 8% greater in OWOB at +10% PSF (P < 0.001). At PSF, OWOB spent less time in single-limb support (33.1% ± 1.5% vs. 34.9% ± 1.6 % gait cycle, P = 0.021) and more time in double-limb support (17.5% ± 1.6% vs 15.4% ± 1.4% gait cycle, P = 0.026) than NW. In OWOB, at PSF, Cw was correlated to impulse (r = -0.57, P = 0.027) and stride frequency (r = 0.51, P = 0.046).

CONCLUSIONS

Excess body weight is associated with greater Cw in older adults, possibly contributing to reduced mobility in overweight and obese older persons.

Effectiveness of a Multi-Component Intervention for Overweight and Obese Children (Nereu Program): A Randomized Controlled Trial

INTRODUCTION

Treatment of childhood obesity is a complex challenge for primary health care professionals.

OBJECTIVES

To evaluate the effectiveness of the Nereu Program in improving anthropometric parameters, physical activity and sedentary behaviours, and dietary intake.

METHODS

Randomized, controlled, multicentre clinical trial comparing Nereu Program and usual counselling group interventions in primary care settings. The 8-month study recruited 113 children aged 6 to 12 years with overweight/obesity. Before recruitment, eligible participants were randomly allocated to an intensive, family-based multi-component behavioural intervention (Nereu Program group) or usual advice from their paediatrician on healthy eating and physical activity. Anthropometric parameters, objectively measured sedentary and physical activity behaviours, and dietary intake were evaluated pre- and post-intervention.

RESULTS

At the end of the study period, both groups achieved a similar decrease in body mass index (BMIsd) compared to baseline. Nereu Program participants (n = 54) showed greater increases in moderate-intense physical activity (+6.27% vs. -0.61%, p<0.001) and daily fruit servings (+0.62 vs. +0.13, p<0.026), and decreased daily soft drinks consumption (-0.26 vs. -0.02, p<0.047), respectively, compared to the counselling group (n = 59).

CONCLUSIONS

At the end of the 8-month intervention, participants in the Nereu Program group showed improvement in physical activity and dietary behaviours, compared to the counselling group.

TRIAL REGISTRATION

ClinicalTrials.gov NCT01878994.

Food intake response to exercise and active video gaming in adolescents: effect of weight status

Although a few data are available regarding the impact of video games on energy intake (EI) in lean adolescents, there is no evidence on the effect of passive and active video gaming on food intake in both lean and obese youth. It is also unknown whether isoenergetic active video games and exercise differently affect food consumption in youth. In all, twelve lean and twelve obese adolescent boys (12-15 years old) had to complete four 1-h sessions in a cross-over design study: control (CON; sitting), passive video game (PVG; boxing game on Xbox 360), active video game (AVG; boxing game on Xbox Kinect 360) and exercise (EX; cycling). The exercise and active video game activities were designed to generate the same energy expenditure (EE). EE was measured using a K4b2 portable indirect calorimeter. Ad libitum food intake and appetite sensations were assessed following the sessions. AVG and EX-EE were significantly higher in obese participants and significantly higher compared with PVG and CON in both groups. Obese participants significantly ate more than lean ones in all four conditions (P<0·001). EI did not differ between conditions in obese participants (CON: 4935 (SD 1490) kJ; PVG: 4902 (SD 1307) kJ; AVG: 4728 (SD 1358) kJ; EX: 4643 (SD 1335) kJ), and was significantly lower in lean participants after EX (2847 (SD 577) kJ) compared with PVG (3580 (SD 863) kJ) and AVG (3485 (SD 643) kJ) (P<0·05). Macronutrient intake was not significantly different between the groups or conditions. Hunger was significantly higher and satiety was lower in obese participants but no condition effect was observed. Overall, moderate-intensity exercise provides better effect on energy balance than an isoenergetic hour of active video gaming in lean adolescent boys by dually affecting EE and EI.

Energetics and mechanics of walking in patients with chronic low back pain and healthy matched controls

PURPOSE

Walking in patients with chronic low back pain (cLBP) is characterized by motor control adaptations as a protective strategy against further injury or pain. The purpose of this study was to compare the preferred walking speed, the biomechanical and the energetic parameters of walking at different speeds between patients with cLBP and healthy men individually matched for age, body mass and height.

METHODS

Energy cost of walking was assessed with a breath-by-breath gas analyser; mechanical and spatiotemporal parameters of walking were computed using two inertial sensors equipped with a triaxial accelerometer and gyroscope and compared in 13 men with cLBP and 13 control men (CTR) during treadmill walking at standard (0.83, 1.11, 1.38, 1.67 m s(-1)) and preferred (PWS) speeds. Low back pain intensity (visual analogue scale, cLBP only) and perceived exertion (Borg scale) were assessed at each walking speed.

RESULTS

PWS was slower in cLBP [1.17 (SD = 0.13) m s(-1)] than in CTR group [1.33 (SD = 0.11) m s(-1); P = 0.002]. No significant difference was observed between groups in mechanical work (P ≥ 0.44), spatiotemporal parameters (P ≥ 0.16) and energy cost of walking (P ≥ 0.36). At the end of the treadmill protocol, perceived exertion was significantly higher in cLBP [11.7 (SD = 2.4)] than in CTR group [9.9 (SD = 1.1); P = 0.01]. Pain intensity did not significantly increase over time (P = 0.21).

CONCLUSIONS

These results do not support the hypothesis of a less efficient walking pattern in patients with cLBP and imply that high walking speeds are well tolerated by patients with moderately disabling cLBP.

Daily physical activity as determined by age, body mass and energy balance

Aim

Insight into the determinants of physical activity, including age, body mass and energy balance, facilitates the design of intervention studies with body mass and energy balance as determinants of health and optimal performance.

Methods

An analysis of physical activity energy expenditure in relation to age and body mass and in relation to energy balance, where activity energy expenditure is derived from daily energy expenditure as measured with doubly labelled water and body movement is measured with accelerometers, was conducted in healthy subjects under daily living conditions over intervals of one or more weeks.

Results

Activity energy expenditure as a fraction of daily energy expenditure is highest in adults at the reproductive age. Then, activity energy expenditure is a function of fat-free mass. Excess body mass as fat does not affect daily activity energy expenditure, but body movement decreases with increasing fatness. Overweight and obesity possibly affect daily physical activity energy expenditure through endurance. Physical activity is affected by energy availability; a negative energy balance induces a reduction of activity expenditure.

Conclusion

Optimal performance and health require prevention of excess body fat and maintenance of energy balance, where energy balance determines physical activity rather than physical activity affecting energy balance.

Gait characteristics of adults with Down syndrome explain their greater metabolic rate during walking

The altered gait patterns of adults with Down syndrome (DS) may contribute to their higher net metabolic rate (net-MR) during walking than adults without DS, leading to mobility limitations. This study examined the extent to which gait characteristics explain differences in net-MR during walking between adults with and without DS. Fifteen adults with DS (27 ± 8 years) and 15 adults without DS (28 ± 6 years) completed two testing sessions in which expiratory gases and kinematic data were collected, respectively, during treadmill walking. Participants walked at six, randomly-presented dimensionless speeds, ranging from slow to fast. Hierarchical and stepwise regressions were used to determine the proportion of the variance in net-MR explained by gait variables that differed between groups, after controlling for variance due to walking speed. Positive work rate, the range of the body center of mass (COM) mediolateral position and its square, variability in the time-course of COM anteroposterior velocity, and the variability of step length, step width, and step time significantly predicted net-MR (p < .05). These variables collectively explained 73.9% of the variance in net-MR that was explained by DS but not by walking speed. After accounting for shared variance among predictors, step length variability made the greatest unique contribution (10.6%) to the higher net-MR in adults with DS, followed by the range of COM mediolateral motion (6.3%), step width variability (2.8%), and variability in COM anteroposterior velocity (0.7%). Therefore, the gait characteristics of adults with DS appear to largely explain their higher net-MR during walking.

Effects of obesity on functional capacity

OBJECTIVE

To assess the relationships between BMI and walking speed, balance control, sit-to-stand performance (a measure of mass specific lower limb power), and endurance.

DESIGN AND METHODS

Thirty-six women with a BMI ≥ 30 kg/m(2) and 10 women with normal body weight (BMI between 18 kg/m(2) and 25 kg/m(2) ) were enrolled in this observational study. The obese group comprised 12 persons with a BMI ≥ 30 and <35 (obese), 14 subjects with a BMI ≥ 35 and <40 (severe obesity) and 10 people with a BMI ≥ 40 kg/m(2) (morbid obesity). All subjects underwent a clinical examination, a gait test, an endurance test (6 minutes walking test), a mass specific lower limb power test (five times sit-to-stand) and a balance test.

RESULTS

Obese women exhibited slower fast gait speeds (P < 0.05) with correspondingly shorter stride lengths, poorer sit-to-stand performance (P < 0.05), and endurance (P < 0.05). However, once the state of severe obesity was reached, additional weight gain (morbid obesity) does not seem to decrease these functional capacities any further.

CONCLUSION

This study underlines the importance of assessing obese patients' related physical problems in an early stage of obesity in order to focus exercise regimens and promote appropriate health behaviors.

Metabolic cost, mechanical work, and efficiency during normal walking in obese and normal-weight children

PURPOSE

This study aimed to investigate the influence of childhood obesity on energetic cost during normal walking and to determine if obese children choose a walking strategy optimizing their gait pattern.

METHOD

Sixteen obese children with no functional abnormalities were matched by age and gender with 16 normal-weight children. All participants were asked to walk along a nearly circular track 30 m in length at a self-selected speed. Spatiotemporal data, kinematics, and ground reaction force were collected during walking using a three-dimensional motion analysis system. Metabolic cost was collected by a portable gas analyzer simultaneously.

RESULTS

The mechanical energy expenditure (MEE) was 72.7% higher in obese children than in normal-weight children. The net metabolic cost was 65.7% higher in obese children. No difference was found in the metabolic rate (J x kg(-1) x m(-1)), normalized MEE (J x kg(-1) x m(-1)) and mechanical efficiency between the obese and normal-weight groups. The obese children walked with a 0.15 m/s slower walking speed, 10.0% shorter cadence, and 30.9% longer double-support phase compared with normal-weight children. In addition, no differences were found in the mediolateral and vertical body center of mass displacement.

CONCLUSION

Body mass played a dominant role in the total metabolic and mechanical cost per stride. Obese children may adopt a walking strategy to avoid an increase in the metabolic cost and the mechanical work required to move their excess body mass.

Effect of obesity onset on pendular energy transduction at spontaneous walking speed: Prader-Willi versus nonsyndromal obese individuals

OBJECTIVE

To compare the mechanical external work (Wext ) and pendular energy transduction (Rstep ) at spontaneous walking speed (Ss ) in individuals with Prader-Willi syndrome (PWS) versus subjects with nonsyndromal obesity (OB) to investigate whether the early onset of obesity allows PWS subjects to adopt energy conserving gait mechanics.

DESIGN AND METHODS

Wext and Rstep were computed using kinematic data acquired by an optoelectronic system and compared in 15 PWS (BMI = 39.5 ± 1.8 kg m(-2) ; 26.7 ± 1.5 year) and 15 OB (BMI = 39.3 ± 1.0 kg m(-2) ; 28.7 ± 1.9 year) adults matched for gender, age and BMI and walking at Ss .

RESULTS

Ss was significantly lower in PWS (0.98 ± 0.03 m s(-1) ) than in OB (1.20 ± 0.02 m s(-1) ; P < 0.001). There were no significant differences in Wext per kilogram between groups (PWS: 0.37 ± 0.04 J kg(-1) m(-1) ; OB: 0.40 ± 0.05 J kg(-1) m(-1) ; P = 0.66) and in Rstep (PWS: 69.9 ± 2.9%; OB: 67.7 ± 2.4%; P = 0.56). However, Rstep normalized to Froude number (Rstep /Fr) was significantly greater in PWS (6.0 ± 0.6) than in OB (3.8 ± 0.2; P = 0.001). Moreover, Rstep /Fr was inversely correlated with age of obesity onset (r = -0.49; P = 0.006) and positively correlated with obesity duration (r = 0.38; P = 0.036).

CONCLUSION

Individuals with PWS seem to alter their gait to improve pendular energy transduction as a result of precocious and chronic adaptation to loading.

Evaluation of cardiorespiratory fitness using three field tests in obese adolescents: validity, sensitivity and prediction of peak VO2

OBJECTIVES

Evaluation of cardiorespiratory fitness in obese adolescents is necessary to develop personalised retraining programmes. We aimed to measure cardiorespiratory fitness using 3 field tests, and to evaluate their validity and sensitivity compared to values obtained by laboratory tests.

DESIGN

Longitudinal interventional study in obese adolescents admitted to a rehabilitation centre for a 9-month programme of obesity management.

METHODS

A 12-min walk/run test, an adapted 20 m shuttle walk-run test (starting speed 4 km h(-1), increments of 0.5 km h(-1)min(-1)) and a 4-level submaximal cycle ergometer test were performed to estimate respectively distance covered in 12 min, maximum speed and maximal aerobic power.

RESULTS

Thirty adolescents aged 14.2 ± 1.6 years were included. After 9 months intervention, we observed a significant reduction in body mass index, and an increase in peak VO2 and field test results. We observed significant correlations between pre- and post-intervention values of peak VO2 and distance covered in 12 min (r=0.70 pre; r=0.82 post), maximum speed (r=0.80 pre; r=0.83 post) and maximal aerobic power (r=0.71 pre; r=0.84 post). Multiple linear regression made it possible to estimate peak VO2 based on results from the 3 field tests using prediction equations specific to a population of obese adolescents.

CONCLUSIONS

These field tests, including the adapted 20 m shuttle walk-run test, adequately assess cardiorespiratory fitness in obese adolescents, and are sensitive to changes over time. Predictive equations including BMI are useful in clinical practice to predict peak VO2 in these patients.

Impact loading and locomotor-respiratory coordination significantly influence breathing dynamics in running humans

Locomotor-respiratory coupling (LRC), phase-locking between breathing and stepping rhythms, occurs in many vertebrates. When quadrupedal mammals gallop, 1∶1 stride per breath coupling is necessitated by pronounced mechanical interactions between locomotion and ventilation. Humans show more flexibility in breathing patterns during locomotion, using LRC ratios of 2∶1, 2.5∶1, 3∶1, or 4∶1 and sometimes no coupling. Previous studies provide conflicting evidence on the mechanical significance of LRC in running humans. Some studies suggest LRC improves breathing efficiency, but others suggest LRC is mechanically insignificant because ‘step-driven flows’ (ventilatory flows attributable to step-induced forces) contribute a negligible fraction of tidal volume. Yet, although step-driven flows are brief, they cause large fluctuations in ventilatory flow. Here we test the hypothesis that running humans use LRC to minimize antagonistic effects of step-driven flows on breathing. We measured locomotor-ventilatory dynamics in 14 subjects running at a self-selected speed (2.6±0.1 ms⁻¹) and compared breathing dynamics in their naturally ‘preferred’ and ‘avoided’ entrainment patterns. Step-driven flows occurred at 1-2X step frequency with peak magnitudes of 0.97±0.45 Ls⁻¹ (mean ±S.D). Step-driven flows varied depending on ventilatory state (high versus low lung volume), suggesting state-dependent changes in compliance and damping of thoraco-abdominal tissues. Subjects naturally preferred LRC patterns that minimized antagonistic interactions and aligned ventilatory transitions with assistive phases of the step. Ventilatory transitions initiated in ‘preferred’ phases within the step cycle occurred 2x faster than those in ‘avoided’ phases. We hypothesize that humans coordinate breathing and locomotion to minimize antagonistic loading of respiratory muscles, reduce work of breathing and minimize rate of fatigue. Future work could address the potential consequences of locomotor-ventilatory interactions for elite endurance athletes and individuals who are overweight or obese, populations in which respiratory muscle fatigue can be limiting.

Humans exploit the biomechanics of bipedal gait during visually guided walking over complex terrain

How do humans achieve such remarkable energetic efficiency when walking over complex terrain such as a rocky trail? Recent research in biomechanics suggests that the efficiency of human walking over flat, obstacle-free terrain derives from the ability to exploit the physical dynamics of our bodies. In this study, we investigated whether this principle also applies to visually guided walking over complex terrain. We found that when humans can see the immediate foreground as little as two step lengths ahead, they are able to choose footholds that allow them to exploit their biomechanical structure as efficiently as they can with unlimited visual information. We conclude that when humans walk over complex terrain, they use visual information from two step lengths ahead to choose footholds that allow them to approximate the energetic efficiency of walking in flat, obstacle-free environments.