A comparison of slow, uphill and fast, level walking on lower extremity biomechanics and tibiofemoral joint loading in obese and nonobese adults

Abstract

We determined if slow, uphill walking (0.75 m/s, 6°) reduced tibiofemoral (TF) loading compared to faster, level walking (1.50 m/s) in obese and nonobese adults. We collected kinematic, kinetic, and electromyographic data as 9 moderately obese and 10 nonobese participants walked on a dual-belt instrumented treadmill. We used OpenSim to scale a musculoskeletal model and calculate joint kinematics, kinetics, muscle forces, and TF forces. Compressive TF forces were greater in the obese adults during both speed/grade combinations. During level walking, obese participants walked with a straighter leg than nonobese participants, resulting in early stance vasti muscle forces that were similar in the obese and nonobese participants. Early stance peak compressive TF forces were reduced by 23% in obese (2,352 to 1,811 N) and 35% in nonobese (1,994 to 1,303 N) individuals during slow, uphill walking compared to brisk level walking. Late stance peak TF forces were similar across speeds/grades, but were greater in obese (∼2,900 N) compared to nonobese (∼1,700 N) individuals. Smaller early stance TF loads and loading rates suggest that slow, uphill walking may be appropriate exercise for obese individuals at risk for musculoskeletal pathology or pain.

Obesity and Chronic Pain

“…For example, thorough biomechanical evaluation suggests that slow uphill walking may be appropriate exercise for obese individuals at risk for musculoskeletal pathology or pain. 130 The functional and structural restrictions produced by the extra loading of the locomotor system in patients with increased BMIs resulted in an anomalous biomechanical pattern during locomotor tasks, producing abnormalities in other connective tissue structures (tendons, ligament, fasciae, bursae) and increased frequency of injuries, including fractures. 131,132 Occupational medicine literature has established that obese men are at increased risk of multiple rib fractures, and obese women are at greater risk of fracture in the vertebral column, leg, ankle, and humerus and at lesser risk of wrist, hip, and pelvis fractures.…”

Spinal motor outputs during step-to-step transitions of diverse human gaits

“…These tasks may also be relevant to clinical, rehabilitation or sport applications. For instance, toe walking is observed in patients with various neurologic and developmental abnormalities (Oetgen and Peden, 2012), backward locomotion is used increasingly in sports and rehabilitation (Hoogkamer et al, 2014) and uphill walking may be appropriate exercise for obese individuals at risk for musculoskeletal pathology or pain (Haight et al, 2014). We used the recordings from 26 leg muscles (including intrinsic foot muscles that have not typically been considered) to reconstruct spinal motor outputs with specific interest in identifying common and idiosyncratic features across locomotor gaits.…”

Six degree-of-freedom knee joint kinematics in obese individuals with knee pain during gait

“…As body mass index (BMI) increases, gait speed decreases [7]. Past studies of knee joint kinematics mainly focused on sagittal and coronal plane motions, i.e., knee joint flexion/extension [5, 8–10] and varus/valgus rotation [9, 10]. Even so, there is no clear consensus on knee joint kinematics in obese individuals during walking.…”

“…Even so, there is no clear consensus on knee joint kinematics in obese individuals during walking. For example, Haight et al[8] reported that obese individuals walked with a less flexed knee during the stance phase compared to non-obese individuals. Vismara et al [11] concluded that the range of knee flexion excursion during gait was not significantly different than a healthy group.…”