The Impact of Obesity and Weight Loss on Gait in Adults - The Mechanobiology of Obesity and Related Diseases - page 128

3.2 Gait Kinematics
The impact of obesity on joint kinematics has been sparsely investigated [ 60 ].
Differences have been reported in hip [ 12 , 24 , 51 ], knee [ 7 , 24 , 48 , 49 ] and ankle
[ 11 , 24 , 33 , 51 , 59 ] joint angles during walking at self-selected and standardized
speeds (Table 2 ). The different study designs and differences in walking speeds
make it difficult to draw solid conclusions about whether obese subjects have
different joint kinematics compared to non-obese subjects. In addition, there have
been differences in measurement methods and gait terminology during the last
decades, and the results cannot therefore be directly compared with each other.
Gait speed has not been standardized in most of the studies that address knee
joint kinematics in the obese. Lai et al. [ 24 ] investigated the joint angles of the hip,
knee and ankle joints in loading response, middle stance and terminal stance
phases of the gait cycle in obese and normal-weight subjects at the self-selected
walking speed (Table 2 ). Greater hip adduction in the frontal plane was found in
the obese group during the terminal stance and pre-swing. The mean knee
adduction angle in the swing phase and the maximum knee adduction angles in
both stance and swing phases were also significantly greater in the obese group.
The mean ankle eversion angle from the middle stance to pre-swing was signifi-
cantly greater in the obese group. Spyropoulos et al. [ 51 ] compared the joint
kinematics of obese and non-obese adult men. They found that the hip abduction
angles of the obese were significantly different in some events of the walking
cycle, and that obese subjects demonstrated a greater ankle dorsiflexion and lesser
ankle plantar flexion throughout the walking cycle (Table 2 ). Freedman Silvernail
et al. [ 16 ] showed that obese subjects walked with a lower peak knee adduction
angle compared to normal BMI subjects, and several of them shifted towards knee
abduction (Table 2 ). Da Silva-Hamu et al. [ 10 ] revealed that although the knee and
ankle flexion angle magnitudes did not differ between obese and normal-weight
women at the self-selected walking speed, the peak flexion angle timings differed.
According to DeVita and Hortobagyi [ 12 ], obese subjects were more erect than
lean adults, with about 5 more extension at the hip, 4 less flexion at the knee and
6 more plantar flexion of the ankle joints throughout the stance phase at the
standard walking speed (Table 2 ). Conversely, Browning et al. [ 7 ] found that
during middle stance the hip, knee, and ankle joint angles in the sagittal plane did
not differ between obese and normal-weight groups at standardized speeds from
0.5 to 1.75 m/s (Table 2 ). Messier et al. [ 33 ] determined the effects of severe
obesity on foot mechanics in adult females during treadmill walking. They showed
that the obese group had a significantly wider range of motion in ankle eversion, a
faster maximum eversion velocity and more forefoot abduction than normal-
weight subjects (Table 2 )[ 33 ].
It has been noted that there are differences in joint kinematics in gait between
obese and normal-weight individuals, but it is not obvious whether the altered
kinematics describes unique gait characteristics in the obese or whether it is
merely the adaption to a slower walking speed [ 60 ]. Obese individuals use a more