The Impact of Obesity and Weight Loss on Gait in Adults - The Mechanobiology of Obesity and Related Diseases - page 135

Fig. 6 The effect of BMI on
knee joint impulsive loading.
Both the knee OA and control
subjects were divided into
three groups based on BMI
(kg/m 2 ): BMI \ 25,
25 B BMI \ 30, and
BMI C 30. Two-way
ANOVA was used in
statistical analysis between
these six groups. The BMI
groups were found to
significantly differ in the
acceleration parameters,
*p \ 0.05, **p \ 0.01

Controls (N = {17,25,11})
Knee OA (N = {11,1 8,24})

3 4

3

2

2

1

**

*

≥ ≥

BMI: <25 25...30 30 <25 25...30 30

5 Effects of Weight Loss on Gait

There are three approaches to the treatment of obesity: lifestyle modification,
pharmacotherapy, and bariatric surgery [ 9 ]. The most effective approach is the
combination of behavioral strategies with diet and exercise to support a sustained
lifestyle change. Pharmacotherapy and bariatric surgery have better outcomes
when augmented by lifestyle treatment compared with either approach alone [ 9 ].
Bariatric surgery, which is being performed increasingly often, is reserved for
those with a BMI of greater than or equal to 40, or a BMI of 35-39.9 when
comorbidities (e.g. knee OA) are present [ 9 ].

5.1 Diet and Exercise

Rather few studies have examined the effects of diet and exercise on gait char-
acteristics. Villareal et al. [ 56 ] investigated in a randomized study the independent
and combined effects of sustained weight loss and regular exercise on walking
speed (i.e. time needed to walk 7.62 m (25 ft.)), among other outcomes, 6 and
12 months after baseline measurements. There was a substantial decrease in body
weight in the diet group (a 10 % decrease from baseline) and in the diet-exercise
group (a 9 % decrease from baseline), but not in the exercise group or in the
control group. In the diet-exercise group and the exercise group, respectively, the
walking speed increased by 23 and 14 % from baseline [ 56 ]. Furthermore, Larsson
et al. [ 25 ] showed that a modest weight reduction of 10 % by dieting significantly
increased the comfortable walking speed (along a 70 m indoor corridor) in the