Effects of body mass index on balance and gait characteristics in the elderly

Abstract

Purpose: The aim of this study was to investigate whether Body Mass Index (BMI) affects balance and gait characteristics in the elderly.

Methods: 105 geriatric individuals were divided into three groups according to the BMI: Normal (18,5<BMI<24.9, n=30), overweight (25.0<BMI<29.9, n=47), obese (30<BMI, n=28). Biodex Balance System was used to measure the balancerelated variables (static balance, dynamic balance, and the sensory interaction of balance). Gait speed was measured using 4m-walk test, stride length and cadence were calculated. The Kruskal-Wallis test was used to analyze between-group differences (p<0.05).

Results: Significant differences were observed between the groups in terms of postural stability index, anteroposterior (AP) index, mediolateral (ML) index, eyes open firm surface (EOFC) balance and eyes closed firm surface (ECFC) balance (p <0.05). Post-hoc analysis showed that the postural stability index, AP index, ML index and EOFC balance of overweight individuals were significantly worse than those of individuals with normal BMI (p=0.008, p=0.014, p=0.005, p<0,001, respectively). While the ECFC balance of obese individuals was significantly worse than those of both individuals with normal BMI and overweight individuals (p<0.001, p=0.005, respectively), their EOFC balance was worse than those with normal BMI (p=0.001). In addition, the stride length of obese individuals was significantly shorter than those of overweight individuals (p=0.008).

Conclusion: It was found that the static balance of the elderly with high body mass index was worse, and the stride length of obese elderly individuals was shorter. These results may be helpful to predict the balance and gait characteristics of the elderly according to their BMI.

Keywords

• body mass index
• elderly
• postural balance
• gait

Yaşlılarda beden kütle indeksinin denge ve yürüme özelliklerine etkisi

Abstract

Amaç: Bu çalışmanın amacı, yaşlılarda beden kütle indeksinin (BKİ) denge ve yürüme özelliklerini ne yönde etkilediğinin araştırılmasıydı.

Yöntem: Yüz beş geriatrik birey BKİ’ye göre üç gruba ayrıldı: Normal (18,5<BKİ<24,9, n=30), pre-obez (25,0<BKİ<29,9, n=47), obez (30<BKİ, n=28). Denge ile ilgili değişkenlerin (statik denge, dinamik denge, duyusal etkileşimli denge) ölçümünde Biodex Denge Sistemi kullanıldı. Yürüme hızı 4m yürüme testi ile ölçüldü, adım uzunluğu ve tempo hesaplandı. Gruplar arası farkların analizi için Kruskal-Wallis testi kullanıldı (p<0,05).

Bulgular: Gruplar arasında postüral stabilite indeksi, anteroposterior (AP) indeksi, mediolateral (ML) indeksi, gözler açık sert zemin (GASZ) denge ve gözler kapalı sert zemin (GKSZ) denge açısından anlamlı farklar olduğu görüldü (p<0,05). Post-hoc analiz sonuçlarına göre pre-obezlerin postüral stabilite indeksi, AP indeksi, ML indeksi ve GASZ dengesi BKİ normal olanlara göre anlamlı olarak daha kötüydü (sırasıyla; p=0,008, p=0,014, p=0,005, p<0,001). Obezlerin GKSZ dengesi hem BKİ normal olanlara hem de pre-obezlere göre anlamlı olarak daha kötü iken (sırasıyla; p<0,001, p=0,005), GASZ dengesi de BKİ normal olanlara göre daha kötüydü (p=0,001). Ayrıca obezlerin adım uzunluğu pre-obezlere göre anlamlı olarak daha kısaydı (p=0,008).

Sonuç: Yüksek beden kütle indeksine sahip yaşlıların statik dengelerinin daha kötü ve obez yaşlıların adım uzunluklarının daha kısa olduğu bulunmuştur. Bu sonuçlar yaşlıların denge ve yürüme özelliklerini, sahip oldukları BKİ’ye göre tahmin etmeye yardımcı olabilir.

Keywords

• beden kütle indeksi
• yaşlı
• postüral denge
• yürüyüş

References

1. 1. Han TS, Tajar A, Lean ME. Obesity and weight management in the elderly. Br Med Bull. 2011;97:169-196.
2. 2. Hergenroeder AL, Wert DM, Hile ES, et al. Association of body mass index with self-report and performance-based measures of balance and mobility. Phys Ther. 2011;91:1223-1234.
3. 3. Mathus-Vliegen EM. Obesity and the elderly. J Clin Gastroenterol. 2012;46:533-544.
4. 4. Rössner S. Obesity in the elderly--a future matter of concern? Obes Rev. 2001;2:183-188.
5. 5. Clinical guidelines on the identification, evaluation, and treatment of overweight and obesity in adults: executive summary. Expert Panel on the Identification, Evaluation, and Treatment of Overweight in Adults. Am J Clin Nutr. 1998;68:899-917.
6. 6. Sack S, Radler DR, Mairella KK, et al. Physical therapists' attitudes, knowledge, and practice approaches regarding people who are obese. Phys Ther. 2009;89:804-815.
7. 7. Hasson CJ, van Emmerik RE, Caldwell GE. Balance decrements are associated with age-related muscle property changes. J Appl Biomech. 2014;30:555-562.
8. 8. Howcroft J, Lemaire ED, Kofman J, et al. Elderly fall risk prediction using static posturography. PLoS One. 2017;12:e0172398.

9. 9. Greve J, Alonso A, Bordini AC, Camanho GL. Correlation between body mass index and postural balance. Clinics (Sao Paulo). 2007;62:717-720.
10. 10. Southard V, Dave A, Douris P. Exploring the Role of Body Mass Index on Balance Reactions and Gait in Overweight Sedentary Middle-aged Adults: A Pilot Study. J Prim Care Community Health. 2010;1:178-183.
11. 11. Hue O, Simoneau M, Marcotte J, et al. Body weight is a strong predictor of postural stability. Gait Posture. 2007;26:32-38.
12. 12. Goulding A, Jones IE, Taylor RW, et al. Dynamic and static tests of balance and postural sway in boys: effects of previous wrist bone fractures and high adiposity. Gait Posture. 2003;17:136-141.
13. 13. Pereira C, Silva RAD, de Oliveira MR, et al. Effect of body mass index and fat mass on balance force platform measurements during a one-legged stance in older adults. Aging Clin Exp Res. 2018;30:441-447.
14. 14. Clinical Guidelines on the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults--The Evidence Report. National Institutes of Health. Obes Res. 1998;6 Suppl 2:51-209.
15. 15. Pickerill ML, Harter RA. Validity and reliability of limits-of-stability testing: a comparison of 2 postural stability evaluation devices. J Athl Train. 2011;46:600-606.
16. 16. Cohen J. Statistical power analysis for the behavioral sciences, 2nd edn. Á/L. Erbaum Press, Hillsdale, NJ, USA; 1988.
17. 17. Cancela Carral JM, Ayán C, Sturzinger L, et al. Relationships Between Body Mass Index and Static and Dynamic Balance in Active and Inactive Older Adults. J Geriatr Phys Ther. 2019;42:85-90.
18. 18. Melzer I, Oddsson LI. Altered characteristics of balance control in obese older adults. Obes Res Clin Pract. 2016;10:151-158.
19. 19. Gouveia É R, Gouveia BR, Ihle A, et al. Balance and mobility relationships in older adults: A representative population-based cross-sectional study in Madeira, Portugal. Arch Gerontol Geriatr. 2019;80:65-69.
20. 20. Minematsu A, Hazaki K, Harano A, et al. Differences in physical function by body mass index in elderly Japanese individuals: The Fujiwara-kyo Study. Obes Res Clin Pract. 2016;10:41-48.
21. 21. Barry E, Galvin R, Keogh C, et al. Is the Timed Up and Go test a useful predictor of risk of falls in community dwelling older adults: a systematic review and meta-analysis. BMC Geriatr. 2014;14:14.
22. 22. Dutil M, Handrigan GA, Corbeil P, et al. The impact of obesity on balance control in community-dwelling older women. Age (Dordr). 2013;35:883-890.
23. 23. Błaszczyk JW, Cieślinska-Swider J, Plewa M, et al. Effects of excessive body weight on postural control. J Biomech. 2009;42:1295-1300.
24. 24. Winter DA. Human balance and posture control during standing and walking. Gait & posture. 1995;3:193-214.
25. 25. Maki BE, Holliday PJ, Topper AK. A prospective study of postural balance and risk of falling in an ambulatory and independent elderly population. J Gerontol. 1994;49:72-84.
26. 26. Teasdale N, Hue O, Marcotte J, et al. Reducing weight increases postural stability in obese and morbid obese men. Int J Obes (Lond). 2007;31:153-160.
27. 27. Massion J. Postural control system. Curr Opin Neurobiol. 1994;4:877-887.
28. 28. Massion J. Postural control systems in developmental perspective. Neurosci Biobehav Rev. 1998;22:465-472.
29. 29. Hardy R, Cooper R, Aihie Sayer A, et al. Body mass index, muscle strength and physical performance in older adults from eight cohort studies: the HALCyon programme. PLoS One. 2013;8:e56483.
30. 30. Liu ZQ, Yang F. Obesity May Not Induce Dynamic Stability Disadvantage during Overground Walking among Young Adults. PLoS One. 2017;12:e0169766.
31. 31. Ko S, Stenholm S, Ferrucci L. Characteristic gait patterns in older adults with obesity--results from the Baltimore Longitudinal Study of Aging. J Biomech. 2010;43:1104-1110.
32. 32. LaCroix AZ, Guralnik JM, Berkman LF, et al. Maintaining mobility in late life. II. Smoking, alcohol consumption, physical activity, and body mass index. Am J Epidemiol. 1993;137:858-869.
33. 33. Corbeil P, Simoneau M, Rancourt D, et al. Increased risk for falling associated with obesity: mathematical modeling of postural control. IEEE Trans Neural Syst Rehabil Eng. 2001;9:126-136.
34. 34. Handrigan GA, Berrigan F, Hue O, et al. The effects of muscle strength on center of pressure-based measures of postural sway in obese and heavy athletic individuals. Gait Posture. 2012;35:88-91.