Elsevier

Gait & Posture

Volume 61, March 2018, Pages 220-225
Gait & Posture

Full length article
Biomechanical characteristics of lower limb gait waveforms: Associations with body fat in children

https://doi.org/10.1016/j.gaitpost.2018.01.019Get rights and content

Highlights

  • Few studies have explored associations between childhood obesity and gait waveforms.

  • Body fat predicted hip and knee flexion, knee internal and ankle external rotation.

  • Greater hip flexion and adduction moments were associated with higher body fat.

  • At the ankle, higher body fat was predictive of greater internal rotation moments.

  • These novel findings suggest altered gait kinematics and kinetics with high body fat.

Abstract

Background

Childhood obesity is associated with musculoskeletal dysfunction and altered lower limb biomechanics during gait. Few previous studies have explored relationships between childhood obesity measured by body fat and lower limb joint waveform kinematics and kinetics.

Research question

What is the association between body fat and hip, knee and ankle joint angles and moments during gait and in 7 to 11 year-old boys?

Methods

Fifty-five boys participated in the study. Body fat was measured by air displacement plethysmography. Hip, knee and ankle 3D waveforms of joint angles and moments were recorded during gait. Principle component analysis was used to reduce the multidimensional nature of the waveform into components representing parts of the gait cycle. Multiple linear regression analysis determined the association between the components with body fat.

Results

Higher body fat predicted greater hip flexion, knee flexion and knee internal rotation during late stance and greater ankle external rotation in late swing/early stance. Greater hip flexion and adduction moments were found in early stance with higher body fat. In mid-stance, greater knee adduction moments were associated with high body fat. Finally, at the ankle, higher body fat was predictive of greater internal rotation moments.

Significance

The study presents novel information on relationships between body fat and kinematic and kinetic waveform analysis of paediatric gait. The findings suggest altered lower limb joint kinematics and kinetics with high body fat in young boys. The findings may help to inform research in to preventing musculoskeletal comorbidities and promoting weight management.

Introduction

Childhood obesity is associated with a greater incidence of musculoskeletal pain and dysfunction. Studies have reported links between orthopaedic conditions (e.g. Slipped Capital Femoral Epiphysis), increased musculoskeletal pain, foot problems, lower limb joint osteoarthritis and aberrant lower limb biomechanics and obesity [[1], [2], [3]]. Excessive and misplaced forces across lower limb joints may predispose to joint dysfunction resulting in increased stress, joint pathology and pain [[4], [5]]. Greater understanding of the biomechanical impact on childhood obesity is important to fully understand the impact of musculoskeletal structure and function, to inform rehabilitation strategies for obesity related joint and soft-tissue dysfunction, and prevent musculoskeletal co-morbidities.

The impact of childhood obesity on clinical gait characteristics has been documented; obese children are reported to walk slower, with a greater base of support and longer stance phase duration [[6], [7]]. To date, five studies have described associations between childhood obesity and three-dimensional (3D) kinematic/kinetic changes in the lower limb [[8], [9], [10], [11], [12]] with conflicting findings. Both significantly greater [9] and lower [11] hip abduction moments have been reported when comparing obese/overweight (OW/OB) children with healthy-weight controls. McMillan et al. [10] reported less hip flexion at initial contact, whereas Cimolin et al. [12] reported greater hip flexion at the same gait event. Three studies have reported reduced knee flexion angle in OW/OB participants [[8], [11], [12]] yet all reported conflicting findings for frontal plane knee moments; Gushue et al. [8] reported greater knee abduction moments, McMillan et al. [11] reported reduced knee abduction moment and Cimolin et al. [12] reported no significant difference. Three studies report reduced ankle plantarflexion moments in OW/OB children [[8], [10], [11]] and one study reported no significant differences [12].

Conflicting findings in previous studies may result from two methodological factors; (1) The definition of obesity used to define groups and, (2) the method of analysing gait data. Earlier studies have used BMI Z-Scores to define OW/OB groups which are based on arbitrary cut-offs (e.g >99%, >97%, >95%) rather than fat measurements as a continuous variable. Furthermore, defining OW/OB by BMI Z-Scores has low sensitivity meaning some OW/OB children are grouped as healthy-weight whereas measures of body fat provide greater confidence in the degree of obesity in children [13]. Previous work by the authors has utilised waveform analysis to determine relationships between foot motion and body fat in the same cohort as that reported in the current article [14]. Analysis of complete waveforms does not rely on the selection of peak or event data to describe gait (commonly reported in previous studies), but instead enables examination over the entirety of the gait cycle.

Looking at the evidence to date, the overall impact of obesity on paediatric gait biomechanics is not understood. However, to the authors’ knowledge, no study has used complete waveform analysis to provide a detailed lower limb kinematic and kinetic analysis in children. The aim of this study was to identify relationships between percentage body fat and lower limb gait waveforms in young boys.

Section snippets

Selection and description of participants

Fifty-five boys, aged 7 to 11 years, participated in the study (Table 1). Ethical approval was obtained (Ref No. ETH/13/11). Participants were recruited from a convenience sample of local schools and clubs. Parental consent and child assent was obtained prior to testing. Participants were excluded from participating if any medical conditions affecting neuromuscular and orthopaedic integrity or any complications contributing to altered foot posture and/or gait disturbance were identified from a

Demographic, anthropometric and spatiotemporal characteristics of the participants

Participant’s demographic, anthropometric and spatiotemporal characteristics are presented (Table 1). Eight participants were classified as obese, 12 participants were classified overweight, 29 as ideal weight and 6 were underweight [16].

Principal component analysis

Mean and standard deviation of joint angular waveforms are presented (Fig. 1). Table 2 presents the results of PCA for the three lower limb joint angles, each joint in three planes of motion. From the hip angular waveform two sagittal, five frontal and three

Discussion

The aim of this study was to analyse complete 3D waveforms of lower limb joint angular motion and joint moments to examine the impact of body fat on gait in young boys. The findings offer novel information about the relationships between angular motion of the lower limb joints and body fat and demonstrates that body fat was associated with altered joint angle and moments of the lower limb during gait.

Our data demonstrated reduced hip extension during the second half of the stance phase with

Summary

The current study presents novel information on the associations between hip, knee and ankle kinematic and kinetic gait waveforms with body fat in 7–11 year-old boys. Utilising the entire kinematics and kinetics waveforms pattern may provide insight into the effects of obesity on gait biomechanics and help to inform further research into preventing musculoskeletal co-morbidities and promoting weight management. The findings of this study have clinical implications for allied health

Conflict of interest

The authors declare that there are no conflict interests.

Acknowledgments

Ryan Mahaffey was funded by the Dr William M. Scholl Podiatric Research and Development Fund

References (30)

  • S.C. Wearing et al.

    The impact of childhood obesity on musculoskeletal form

    Obes. Rev.

    (2006)
  • S.P. Shultz et al.

    Paediatric obesity, physical activity and the musculoskeletal system

    Obes. Rev.

    (2009)
  • A.P. Hills et al.

    The contribution of physical activity and sedentary behaviours to the growth and development of children and adolescents: implications for overweight and obesity

    Sports Med

    (2007)
  • S.P. Shultz et al.

    Childhood obesity and walking: guidelines and challenges

    Int J Pediatr Obes

    (2011)
  • A.P. Hills et al.

    Gait characteristics of obese children

    Arch. Phys. Med. Rehabil.

    (1991)
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