Effects of a lower extremity exercise program on gait biomechanics and clinical outcomes in children and adolescents with obesity: A randomized controlled trial.

Gait & posture. 2019;70:122-129

Plain language summary

Findings through studies place overweight and obesity as one of the most critical and accelerating global health issues. Besides the commonly linked health risks of obesity and overweight, literature also highlights that they may result in an increased risk of developing unfavourable gait patterns and lower-extremity skeletal malalignments. The main aim of this study was to evaluate an exercise programme (EP) that combines strength and neuromuscular exercises from a knee health and muscle strength perspective. The study is a single blinded, randomised controlled study which enrolled 51 children and adolescents aged between 10 and 18 years of age. The participants were randomly assigned to one of the two groups: EP group or control group. Results indicate that the EP was able to modify biomechanical gait patterns at the pelvic and hip level. Furthermore, results did not show any changes in relation to pain or other clinical symptoms. Authors conclude that EP might be an effective short-term possibility to counteract the progressive development of biomechanical malalignments of the lower extremity.

Abstract

BACKGROUND Research highlights the detrimental effects of obesity on gait biomechanics and the accompanied risk of lower-extremity skeletal malalignments, increased joint stress, pain and discomfort. Individuals with obesity typically show increased knee valgus angles combined with an increased step width. Accompanying muscular dysfunctions impede their ability to compensate for these alterations, especially in the frontal plane. To date, no studies are available, which evaluated the potential effects of an exercise program (EP) in reducing these unfavorable biomechanical changes. RESEARCH QUESTIONS Is a 12-week EP, which includes hip abductor and knee extensor strength exercises and fosters dynamic knee alignment, effective in positively altering gait biomechanics in children and adolescents with obesity? METHODS This study was a randomized controlled trial having children and adolescents with obesity assigned to an EP (n = 19) or control (n = 16) group. Pain, self-rated knee function, muscle strength and 3D gait analysis during walking and stair climbing were evaluated. RESULTS Results indicate that the EP was able to increase muscular strength especially in the hip abductors. In addition, children from the EP group walked with less maximum hip adduction and reduced pelvic drop during weight acceptance at follow-up. No changes were present in self-rated knee function, pain or discomfort. SIGNIFICANCE Even though effects were small, results indicate that an EP is an effective short-term possibility to counteract the progressive development of biomechanical malalignments of the lower extremity. Clinical parameters indicated that the program was feasible. Nonetheless, low adherence highlights the need to develop more attractive programs. CLINICAL TRIALS REG. NO: clinicaltrials.gov (NCT02545764).

Lifestyle medicine

Fundamental Clinical Imbalances : Structural
Patient Centred Factors : Triggers/Obesity/exercise
Environmental Inputs : Physical exercise
Personal Lifestyle Factors : Exercise and movement
Functional Laboratory Testing : Not applicable

Methodological quality

Jadad score : 3
Allocation concealment : Yes

Metadata

Nutrition Evidence keywords : Obesity ; Overweight ; Physical activity ; Body mass index ; BMI