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

Abstract

It is known that obesity is associated with biomechanical alterations during locomotor tasks, which is considered a potential risk factor for the development of musculoskeletal disorders (MSKD). However, the association of obesity with biomechanical alterations of walking in the early stages of life have not yet been systematically reviewed.Thus, this review aims to summarize the biomechanical characteristics of walking in children and adolescents with overweight/obesity (OW/OB) versus their normalweight (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.

Obesity, the new childhood disability? An umbrella review on the association between adiposity and physical function

“…Five SRs exclusively examined longitudinal studies, 28,30,[35][36][37] and three only examined cross-sectional studies. 33,38,39 Seventy-nine of the 349 unique primary relevant studies were included in two or more SRs (23%, mean 1.32 SRs; range 1-5 SRs). CCA index for relevant primary studies was 1.6% (classified as very slight overlap).…”

“…Some SRs classified the strength of evidence according to the quality and/or percentage of studies supporting an association. 28,[31][32][33][34]39,41,45 Others used Grading of Recommendations, Assessment, Development and Evaluation (GRADE) framework. 30,38,43,46 3.1 | Mapping of studies within ICF…”

“…Obesity-related alterations in gait patterns were reported in a number of studies in one SR. 39 Specifically, children with obesity experience increased pelvic, hip and knee joint motion; lower extremity joint moments/power generation/absorption; step width and stance phase. Excessive body mass may not be the only explanation for biomechanical alterations; there was some suggestion of adaptive changes in gait patterns supported by studies showing altered patterns of hip power generation after adjusting for body mass.…”

“…39 The authors also indicated that certain deviations may suggest reduced stability or motor control (e.g., greater pelvic motion, wider base/step width and longer stance phase). 39 Functionally, biomechanical deviations may mean that walking is less efficient, and there are suggestions that elevated joint loading and biomechanical impairments may play a role in MS pain or injury. 59 As suggested by Molina-Garcia et al, 39 it is also possible that gait difficulty/biomechanical impairment may further contribute to obesity.…”

“…All SRs of motor skill performance[31][32][33]38,41,47 reported on standardized assessment batteries (e.g., Test of Gross Motor Development). One SR39 focussed on gait biomechanics, evaluated using laboratory-based methods. Running speed and/or agility and associations with adiposity were explored in three SRs,28,38,47 examining shuttle runs, sprints or a subset of the BOTMP second edition.…”