Effect of Obesity on Knee and Ankle Biomechanics during Walking

DXA-based appendicular composition measures in healthy aging Caucasian Greek women: a cross-sectional study

As the global population of older persons increases, age-related medical conditions will have a greater impact on public health. DXA-derived bone and soft tissue metrics are associated with adverse clinical events in aging persons. This study aims to investigate the regional body composition of the appendices by whole-body DXA scans, and the age-related relationships between measures of bone and soft tissue in healthy Caucasian females of a Greek origin residing in the Mediterranean area. Body composition of the legs and the arms was analyzed, and lean mass (LM) and fat mass (FM) metrics were calculated in 330 women aged 20-85 years, using DXA. Peak bone mineral density (BMD) of the legs and arms was achieved between ages 20-30 and 41-50 years, respectively. The overall BMD reduction with age was for the legs 43% and the arms 32.2% (p < 0.001). Peak %LM of the legs and the arms was achieved between ages 20-30. The overall reduction of %LM with age was for the legs 22.5% (p < 0.001) and arms 6.6% (p < 0.05). Peak %FM of the legs and arms was attained between ages 31-40 and 61-70, respectively. The overall %FM reduction with age was for the legs and arms 7.5% and 1.9% (p > 0.05). In appendicular sites, Greek women reach peak values of bone mass in the legs first, in early adulthood. Bone loss predominates in the legs as women age. Also, with advancing age Greek women show preferential significant decreases of %LM and %FM in the legs as opposed to the arms. Although variation in appendicular bone and soft tissue metrics is present, the implications of variable biological crosstalks among the tissue components as women age may ultimately lay the foundation for future clinical trials aimed at healthy aging.

Clinical and radiographic characterization of three-dimensional gait profiles of patients with knee osteoarthritis

BACKGROUND

Previous authors have utilized gait kinematics to categorize knee osteoarthritis patients into four distinct profiles: (1) flexed knee; (2) externally rotated knee; (3) stiff knee; and (4) knee varus thrust and rotational rigidity. However, the relationship between these gait profiles and patients' characteristics remains poorly understood. Thus, this study aimed to investigate whether differences in clinical and radiographic characteristics were associated with these four gait profiles.

METHODS

This cross-sectional study used available data from a previous biomechanical study. Data on the four gait profiles were collected from 42 patients with advanced knee osteoarthritis. Three-dimensional kinematics of the knee was recorded during gait using an optoelectronic system. Subjects were evaluated for knee strength, range of motion, tibial slope, femorotibial angle, radiographic severity, anthropometric measurements, and patient-reported outcomes. Multiple comparisons were made using Dunn's test. The level of significance was set at 5%, and the effect size was calculated.

FINDINGS

Body mass index (BMI) was the only variable associated with a specific gait profile: profile 4 (P = 0.01; effect size = P1 × P4: -0.62; P2 × P4: -0.41; P3 × P4: -0.40).

INTERPRETATION

Our findings suggest that most clinical and radiographic characteristics commonly measured in clinical practice did not differ significantly among knee osteoarthritis patients with the four different gait profiles. The only exception was a higher BMI noted in those with gait profile 4; however, it remains unclear whether it can cause varus thrust or rotation rigidity. The incorporation of three-dimensional motion analysis to identify gait profiles provided clinical insights beyond the limitations of traditional clinical assessments.

The biomechanical effects of insoles with different cushioning on the knee joints of people with different body mass index grades

Background: Enhancing knee protection for individuals who are overweight and obese is crucial. Cushioning insoles may improve knee biomechanics and play a significant protective role. However, the impact of insoles with varying cushioning properties on knee joints in individuals with different body mass index (BMI) categories remains unknown. Our aim was to investigate the biomechanical effects of insoles with different cushioning properties on knee joints across different BMI grades. Methods: Gravity-driven impact tests were used to characterize the cushioning properties of three types of Artificial Cartilage Foam (ACF18, 28, and 38) and ethylene-vinyl acetate (EVA) insoles. Knee joint sagittal, coronal, and vertical axis angles and moments were collected from healthy-weight (BMI 18.5-23.9 kg/m2, n = 15), overweight (BMI 24.0-27.9 kg/m2, n = 16), and obese (BMI ≥28.0 kg/m2, n = 15) individuals randomly assigned four different insoles during a drop jump. The Kruskal-Wallis test and mixed model repeated measures analysis of variance were used to compare differences among cushioning and biomechanical data across various insoles, respectively. Results: ACF showed higher cushioning than EVA, and ACF38 was the highest among the three types of ACF (all p < 0.001). During the drop jump, the knee flexion angles and moments of the ACF insoles were lower than those of the EVA insoles, the knee adduction angles of the ACF18 and ACF28 insoles were lower than those of the EVA insoles, and ACF18 insoles increased the first cushion time (all p < 0.05) for all participants in whom biomechanical variables demonstrated no interactions between insoles and BMI. Regarding the BMI-dependent biomechanical variables, compared with the EVA insoles, ACF28 insoles decreased the knee flexion angle and ACF38 insoles decreased the knee adduction and rotation moment in the healthy-weight group; ACF18 insoles decreased the knee flexion angle and ACF38 insoles decreased the knee moment in the overweight group; ACF28 insoles decreased the knee flexion and adduction moment, and ACF38 insoles decreased the knee flexion angle and rotation moment in the obese group (all p < 0.05). Conclusion: Insoles with higher cushioning properties could improve knee biomechanics and provide better knee joint protection in people across different BMI ranges.

Comparative analysis of ankle injury kinematics and dynamics in basketball players: forefoot landing vs. rearfoot landing modes

OBJECTIVE

To compare the differences in ankle joint parameters of basketball athletes between the forefoot and rearfoot landing and to investigate the injury mechanism of ankle joints in different landing modes.

METHODS

Twenty level II male basketball athletes were selected as subjects in this study. The landing movements of these athletes were assigned into a forefoot landing mode and a rearfoot landing mode. The former includes movements such as running emergency stop, two-leg jump and forefoot landing, while the latter includes actions such as running emergency stop, two-leg jump and rearfoot landing. The motion capture system and three-dimensional force measuring table were used for collecting the kinematic and dynamic data of the subjects.

RESULTS

The initial landing angles, including ankle dorsiflexion and medial ankle rotation of the forefoot were larger than those of the rearfoot (all P<0.05). Compared to those in the rearfoot landing mode, the forefoot landing exhibited a greater peak angle of ankle plantar flexion and ankle varus, as well as a smaller peak angle of ankle dorsiflexion and ankle internal rotation (all P<0.05). In comparison to the rearfoot landing mode, the forefoot landing showed a larger range of ankle varus and valgus, as well as a smaller range of ankle dorsiflexion and plantar flexion (all P<0.05). The ankle plantar flexion torque of forefoot landing was higher than that of rearfoot landing, while the peak ankle dorsiflexion torque of forefoot landing was smaller than that of rearfoot landing (all P<0.05). Compared to those in the rearfoot landing mode, the outward peak ground reaction force was smaller and the forward peak ground reaction was larger in forefoot landing mode (all P<0.05). No obvious differences were observed in other indicators between two landing modes.

CONCLUSIONS

There are kinematic and dynamic differences between the forefoot and rearfoot landing. Forefoot landing may increase the risk of ankle injury during landing.

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

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

Total Ankle Arthroplasty: Does Obesity Matter?

BACKGROUND

There is limited data evaluating the effect of obesity on outcomes following total ankle arthroplasty (TAA), especially in adequate sample sizes to detect impacts on patient-reported outcomes (PROs). The purpose of this study was to assess the effect of obesity on complication rates and PROs.

METHODS

This was a single-institution, retrospective study of 1093 primary TAA performed between 2001 and 2020. Minimum follow-up was 2 years. Patients were stratified by body mass index (BMI) into control (BMI = 18.5-29.9; n = 615), obesity class I (BMI = 30.0-34.9; n = 285), and obesity class II (BMI > 35.0; n = 193) groups. Patient information, intraoperative variables, postoperative complications, and PRO measures were compared between groups using univariable statistics. Multivariable Cox regression was performed to assess risk for implant failure. Mean follow-up was 5.6 years (SD: 3.1).

RESULTS

Compared to control and class I, class II patients had the lowest mean age (P = .001), highest mean ASA score (P < .001), and greatest proportion of female sex (P < .001) and Black/African American race (P = .005). There were no statistically significant differences in postoperative complications (infection, implant failure, or impingement) across the BMI classes (P > .05).Preoperatively, class II had lower (worse) mean scores for Foot and Ankle Outcome Score pain and ADL subscales than controls (post hoc pairwise P < .001 for both). At final follow-up, both class II and class I had lower (worse) mean Short Musculoskeletal Function Assessment (post hoc pairwise P < .001 and P = .030, respectively) and 36-Item Short Form Health Survey scores (post hoc pairwise P < .001 and P = .005, respectively) than controls.

CONCLUSION

At midterm follow-up, obesity was not associated with increased rates of complications after TAA. Patients with obesity reported worse musculoskeletal function and overall quality of life after TAA but there was no differential improvement in PROs across BMI classes. To our knowledge, this is the largest single-institution study to date examining the effect of obesity on outcomes after primary TAA.

LEVEL OF EVIDENCE

Level III, retrospective comparative study.

A Systematic Review of the Influence of Overweight and Obesity across the Lifespan on Obstacle Crossing during Walking

This study aimed to systematically review and summarize the available data regarding the influence of overweight and obesity across the lifespan on obstacle crossing during walking. Four databases were systematically searched with no limitation on publication date following the Cochrane Handbook for Systematic Reviews and PRISMA guidelines. Only full-text English-language articles published in a peer-reviewed journal were eligible. They had to compare obstacle crossing during walking by overweight or obese individuals with individuals of normal body weight. Five studies were considered eligible. All the studies assessed kinematics; only one assessed kinetics, but none investigated muscle activity or obstacle contact. Compared to normal individuals crossing obstacles, overweight or obese individuals exhibited lower velocity, shorter step length, lower cadence, and less time spent in single-limb support. They also exhibited increased step width, more time spent in double support, and greater trailing leg ground force reaction and centre of mass acceleration. Overall, the small number of included studies did not allow us to draw any conclusions. However, being overweight or obese seems to have a potentially negative influence on the kinematics of gait parameters due to a tendency to trip, fall, and suffer severe fall-related injuries when negotiating obstacles on foot in real-life environments.

Forward and Backward Walking: Multifactorial Characterization of Gait Parameters

Although extensive literature exists on forward and backward walking, a comprehensive assessment of gait parameters on a wide and homogenous population is missing. Thus, the purpose of this study is to analyse the differences between the two gait typologies on a relatively large sample. Twenty-four healthy young adults participated in this study. By means of a marker-based optoelectronic system and force platforms, differences between forward and backward walking were outlined in terms of kinematics and kinetics. Statistically, significant differences were observed in most of the spatial-temporal parameters, evidencing some adaptation mechanisms in backward walking. Differently from the ankle joint, the hip and knee range of motion was significantly reduced when switching from forward to backward walking. In terms of kinetics, hip and ankle moment patterns for forward and backward walking were approximately mirrored images of each other. Moreover, joint powers appeared drastically reduced during reversed gait. Specifically, valuable differences in terms of produced and absorbed joint powers between forward and backward walking were pointed out. The outcomes of this study could represent a useful reference data for future investigation evaluating the efficacy of backward walking as a rehabilitation tool for pathological subjects.

Effect of multi-component exercises program on pain-related gait adaptations among individuals with osteoarthritis of the knee joint

BACKGROUND

Osteoarthritis of the knee causes pain and gait disturbances, as well as a distinct gait pattern. Patients with knee OA have decreased range of motion (ROM) and increased ground reaction force. OA reduces stride length and walking speed.

OBJECTIVES

To determine the effect of a multi-component exercise program on pain-related gait adaptations among individuals with osteoarthritis of the knee joint and to compare the effect of multi-component exercises with traditional exercises on pain-related gait adaptations among individuals with osteoarthritis of the knee joint.

MATERIALS AND METHODS

This was an experimental study done between 120 patients having knee OA, of both genders, and between the age group of 50-65 years. These individuals were residents of the city of Karad and they were randomly divided into group A (conventional/traditional) and group B (experimental). A pretest assessment was done and the treatment was given for 6 weeks. The later posttest assessment was done and further statistical tests like paired and unpaired t tests were used.

RESULTS

Among the 120 subjects with OA knee, the age group of 60-65 years (44%) was found to be commonly affected. Thirty-nine were males (32.5%) and 81 were females (67.5%). Fifty-eight subjects (48%) were found to be commonly overweight. Thirty-two subjects (27%) had Genu Valgum deformity, and 88 subjects (73%) had Genu Varum deformity at the knee joint. The Pvalue within both group A and group B was found to be statistically significant for the entire outcome measures used for assessment. The pretest vs post test values of the WOMAC scale for patients with knee OA within both groups were found to be extremely significant (P < 0.0001). As for the MMT score in these patients, the Knee Flexors of Group A were not significant for right side (P = 0.7088) as well as for left side (P = 0.083) and in Group B they were extremely significant (P < 0.0001) for both sides. For the ROM scores within both groups, Knee Flexion of Group A for both sides was found to be extremely significant (P < 0.0001) for both sides. And for the pretest vs posttest values of within the groups'gait parameters among these patients with OA knees, for cadence both groups B were found to be extremely significant (P < 0.0001). The stride length for Group A was found to be very significant (P = 0.0060) and for Group B it was (P < 0.0001). Also, the P values of the various outcome measures between both groups were found to have statistical significance of their own.

CONCLUSION

Effect of Multi-Component Exercise Program on Pain-Related Gait Adaptations Among Individuals with Osteoarthritis of the Knee joint was found to be significant in pain reduction, improving strength, range of motion, and the gait parameters such as an increase in cadence, stride length, step length and decrease in the step width.

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

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

Contribution of lower extremity muscles to center of mass acceleration during walking: Effect of body weight

Overweight or obesity is known to be associated with altered activations of lower extremity muscles. Such changes in muscular function may lead to the development of mobility impairments or joint diseases. However, little is known about how individual lower extremity muscles contribute to the whole-body center of mass (COM) control during walking and the effect of body weight. This study examined the contribution of individual lower extremity muscle force to the COM accelerations during walking in overweight and non-overweight individuals. Musculoskeletal simulations were performed for the stance phase of walking with data collected from 11 overweight and 13 non-overweight adults to estimate lower extremity muscle forces and their contributions to the COM acceleration. Mean time-series data from each parameter were compared between body size groups using Statistical Parametric Mapping. Compared to the non-overweight group, the overweight group revealed a greater gastrocnemius contribution to the mediolateral (p = 0.006) and vertical (p < 0.001) COM accelerations during mid-stance, and had a lower vastus contribution to the anteroposterior COM acceleration (p < 0.001) during pre-swing. Increased contributions from the large posterior calf muscles to the mediolateral COM acceleration may be related to efforts to alleviate COM sway in overweight individuals.

High BMI and the risk of lower extremity fractures in fertile-aged women: A nationwide register-based study in Finland

OBJECTIVES

Both high and low body mass index (BMI) is known to be associated with increased risk for osteoporotic fractures in the postmenopausal population. However, the association between BMI and risk for fracture in the fertile-aged (15-49 years) population is not well studied. We aim to examine how increased BMI affects the risk for fracture leading to hospitalization after delivery in fertile-aged women.

MATERIAL AND METHODS

In this nationwide registry-based study, data on all women aged 15-49 years with fractures leading to hospitalization were retrieved from the Care Register for Health Care for the years 2004-2018. The data were linked with data from the National Birth Register, where the BMI status is collected for each pregnancy. Cox regression was used to examine the effect of increased BMI on the risk for fracture within five years after delivery. Risks were analyzed separately for upper extremity, spine and pelvis, and lower extremity fractures. The results were interpreted with hazard ratios (HR), adjusted hazard ratios (aHR), and 95% confidence intervals (CI).

RESULTS

A total of 529 992 pregnant women with 3276 fractures leading to hospitalization within 5-year follow-up were included in this study. Of these, a total of 548 fractures required surgical treatment. Patients with BMI of 30 kg/m² or more had a higher rate of fractures in the lower extremity (≥50%). In lower extremity fractures, risk for fracture increased with increasing BMI. The risk fracture was highest in the group with BMI of 35-40 kg/m² (overall lower extremity aHR 2.43 95% CI 1.92-3.06; knee aHR 2.04, 95% CI 1.45-2.87; ankle aHR 3.01, 95% CI 2.16-4.20).

CONCLUSIONS

Higher BMI was associated to the increased risk for lower extremity fractures, especially ankle fractures, within five years of delivery. Information gained from this study is important in the clinical setting, as patients can be informed of the negative effect of obesity on the post-delivery risk for fractures.

Obesity, Inflammation, and Immune System in Osteoarthritis

Obesity remains the most important risk factor for the incidence and progression of osteoarthritis (OA). The leading cause of OA was believed to be overloading the joints due to excess weight which in turn leads to the destruction of articular cartilage. However, recent studies have proved otherwise, various other factors like adipose deposition, insulin resistance, and especially the improper coordination of innate and adaptive immune responses may lead to the initiation and progression of obesity-associated OA. It is becoming increasingly evident that multiple inflammatory cells are recruited into the synovial joint that serves an important role in pathological changes in the synovial joint. Polarization of macrophages and macrophage-produced mediators are extensively studied and linked to the inflammatory and destructive responses in the OA synovium and cartilage. However, the role of other major innate immune cells such as neutrophils, eosinophils, and dendritic cells in the pathogenesis of OA has not been fully evaluated. Although cells of the adaptive immune system contribute to the pathogenesis of obesity-induced OA is still under exploration, a quantity of literature indicates OA synovium has an enriched population of T cells and B cells compared with healthy control. The interplay between a variety of immune cells and other cells that reside in the articular joints may constitute a vicious cycle, leading to pathological changes of the articular joint in obese individuals. This review addresses obesity and the role of all the immune cells that are involved in OA and summarised animal studies and human trials and knowledge gaps between the studies have been highlighted. The review also touches base on the interventions currently in clinical trials, different stages of the testing, and their shortcomings are also discussed to understand the future direction which could help in understanding the multifactorial aspects of OA where inflammation has a significant function.

The Effects of Overweight and Obesity on Obstacle Crossing During Walking: Protocol for a Systematic Review

BACKGROUND

Overweight and obesity are significant global health concerns that involve deficits in gait and balance that affect daily activities. Although much is reported about the effect of overweight and obesity on gait during unobstructed walking, not much is known about how overweight and obesity could impact gait under more challenging conditions, such as environments with obstacles.

OBJECTIVE

The aim of this study is to systematically review and synthesize the available data regarding the effects of overweight and obesity on obstacle crossing during walking.

METHODS

This review will follow the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guidelines. PubMed, Web of Science, Scopus, and SPORTDiscus will be systematically searched with no limitations on publication date. Only full-text English-language articles published in a peer-reviewed journal will be included. Included articles must have compared obstacle crossing during walking in individuals with overweight or obesity to individuals of normal body weight. A total of 2 independent reviewers will select the articles and extract the following 4 sets of data: (1) study characteristics, (2) sample description, (3) obstacle crossing task protocol, and (4) main results obtained. If a considerable number of homogeneous papers are included, a meta-analysis will be conducted. A preliminary search was conducted in November 2021.

RESULTS

The results will include the article selection flowchart as well as tables and figures synthesizing the extracted data on the effects of overweight and obesity on obstacle crossing during walking. The preliminary search identified 73 original records, of which 5 articles met the inclusion criteria.

CONCLUSIONS

This review will present researchers and clinicians with an overview of published studies that have compared the performance of obstacle crossing for individuals with overweight and obesity to those of normal body weight. Gaining insight into the control strategies adopted by individuals with overweight and obesity is critical for safe and successful obstacle crossing in this population. We therefore believe that our findings could be useful for identifying people at risk of falls and developing and implementing fall prevention programs for individuals with overweight and obesity.

TRIAL REGISTRATION

PROSPERO CRD42021269949; https://tinyurl.com/3yrwccu4.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/36234.

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

Background

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

Method

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

Results

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

Conclusions

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

Graphical Abstract

A Comparative Analysis of Shoes Designed for Subjects with Obesity Using a Single Inertial Sensor: Preliminary Results

Walking remains a highly recommended form of exercise for the management of obesity. Thus, comfortable and adequate shoes represent, together with the prescription of a safe adapted physical activity, an important means to achieve the recommended physical activity target volume. However, the literature on shoes specific for obese individuals is inadequate. The aim of the present study was to compare the performance of shoes specifically designed for subjects with obesity with everyday sneakers during instrumented 6-min walking test and outdoor 30-min ambulation in a group of subjects with obesity using a single wearable device. Twenty-three obese individuals (mean age 58.96 years) were recruited and classified into two groups: deconditioned (n = 13) and non-deconditioned patients (n = 10). Each participant was evaluated with his/her daily sneakers and the day after with shoes specifically designed for people with obesity by means of a questionnaire related to the comfort related to each model of shoes and instrumentally during the i6MWT and an outdoor walking test. The results showed that the specifically designed shoes displayed the higher score as for comfort, in particular in the deconditioned group. During the i6MWT, the distance walked, and step length significantly increased in the deconditioned group when specifically designed shoes were worn; no significant changes were observed in the non-deconditioned individuals. The deconditioned group displayed longer step length during the outdoor 30-min ambulation test. In the non-deconditioned group, the use of specific shoes correlated to better performance in terms of gait speed and cadence. These data, although preliminary, seem to support the hypothesis that shoes specifically conceived and designed for counteracting some of the known functional limitations in subjects with obesity allow for a smoother, more stable and possibly less fatiguing gait schema over time.