Effects of Obesity and Fall Risk on Gait and Posture of Community- Dwelling Older Adults
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Published
Jan 1, 2019
Thurmon E. Lockhart
Christopher W. Frames
Rahul Soangra
Abraham Lieberman
Abstract
Epidemiological studies link increased fall risk to obesity in older adults, but the mechanism through which obesity increases falls and fall risks is unknown. This study investigates if obesity (Body Mass Index: BM I> 30 kg/m2 ) influenced gait and standing postural characteristics of community dwelling older adults leading to increased risk of falls. One hundred healthy older adults ( age 74.0 ± 7.6 years, range of 56-90 years ) living independently in a community participated in this study. Participants’ history of falls over the previous two years was recorded, with emphasis on frequency and characteristics of falls. Participants with at least two falls in the prior year were classified as fallers. Each individual was assessed for
postural stability during quiet stance and gait stability during 10 meters walking. Fall risk parameters of postural sway ( COP area, velocity, path-length ) were measured utilizing a standard forceplate coupled with an accelerometer affixed at the sternum. Additionally, parameters of gait stability ( walking velocity, double support time, and double support time variability ) were assessed utilizing an accelerometer affixed at the
participant’s sternum. Gait and postural stability analyses indicate that obese older adults who fell have significantly altered gait pattern ( longer double support time and greater variability ) exhibiting a loss of automaticity in walking and, postural instability as compared to their counterparts ( i.e., higher sway area and path length, and higher sway velocity ) further increasing the risk of a fall given a perturbation. Body weight/BMI is a risk factor for falls in older adults as measured by gait and postural stability parameters.
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Keywords
Lyapunov Stability, Accelerometer, biomedical healthcare devices
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the assessment of daily physical activity. IEEE Transactions on Biomedical Engineering, 44(3), 136-147. doi:10.1109/10.554760
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Bussmann, J. B. J., Martens, W. L. J., Tulen, J. H. M., Schasfoort, F. C., van den Berg-Emons, H. J. G., & Stam, H. J. (2001). Measuring daily behavior using
ambulatory accelerometry: The Activity Monitor. Behavior Research Methods, Instruments, & Computers, 33(3), 349-356. doi:10.3758/ bf03195388
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Postmenopausal Women: GLOW. The American Journal of Medicine, 124(11), 1043-1050. doi: 10.1016/j.amjmed.2011.06.013
Corbeil, P., Simoneau, M., Rancourt, D., Tremblay, A., & Teasdale, N. (2001). Increased risk for falling associated with obesity: mathematical modeling of postural control. IEEE Transactions on Neural Systems and Rehabilitation Engineering, 9(2), 126-136. doi:10.1109/7333.928572
Delmonico, M. J., Harris, T. B., Visser, M., Park, S. W., Conroy, M. B., Velasquez-Mieyer, P., . . . Goodpaster, B. H. (2009). Longitudinal study of muscle strength, quality, and adipose tissue infiltration. The American Journal of Clinical Nutrition, 90(6), 1579-1585. doi:10.3945/ajcn.2009.28047
Der Wiel, A. B.-v., Gussekloo, J., De Craen, A. J. M., Van Exel, E., Bloem, B. R., & Westendorp, R. G. J. (2002). Common Chronic Diseases and General
Impairments as Determinants of Walking Disability in the Oldest-Old Population. Journal of the American Geriatrics Society, 50(8), 1405-1410. doi:10.1046/j.1532-5415.2002.50363.x
Doheny, E. P., McGrath, D., Greene, B. R., Walsh, L., McKeown, D., Cunningham, C., . . . Caulfield, B. (2012). Displacement of centre of mass during
quiet standing assessed using accelerometry in older fallers and non-fallers. Conf Proc IEEE Eng Med Biol Soc, 2012, 3300-3303. doi:10.1109/EMBC.2012.6346670
Duvigneaud, N., Matton, L., Wijndaele, K., Deriemaeker, P., Lefevre, J., Philippaerts, R., . . . Duquet, W. (2008). Relationship of obesity with physical activity, aerobic fitness and muscle strength in Flemish adults. J Sports Med Phys Fitness, 48(2), 201-210.
Finkelstein, E. A., Chen, H., Prabhu, M., Trogdon, J. G., & Corso, P. S. (2016). The Relationship between Obesity and Injuries among U.S. Adults. American Journal of Health Promotion, 21(5), 460-468. doi: 10.4278/0890-1171-21.5.460
Fino, P., Frames, C., & Lockhart, T. (2015). Classifying Step and Spin Turns Using Wireless Gyroscopes and Implications for Fall Risk Assessments. Sensors, 15(5), 10676-10685. doi:10.3390/s150510676
Fino, P. C., Mojdehi, A. R., Adjerid, K., Habibi, M., Lockhart, T. E., & Ross, S. D. (2015). Comparing Postural Stability Entropy Analyses to Differentiate
Fallers and Non-fallers. Annals of Biomedical Engineering, 44(5), 1636-1645. doi:10.1007/ s10439-015-1479-0
Fjeldstad, C., Fjeldstad, A. S., Acree, L. S., Nickel, K. J., & Gardner, A. W. (2008). The influence of obesity on falls and quality of life. Dynamic Medicine, 7(1), 4. doi:10.1186/1476-5918-7-4
Flegal, K. M. (2010). Prevalence and Trends in Obesity Among US Adults, 1999-2008. JAMA, 303(3), 235. doi:10.1001/jama.2009.2014
Flegal, K. M., Williamson, D. F., Pamuk, E. R., & Rosenberg, H. M. (2004). Estimating Deaths Attributable to Obesity in the United States. American Journal of Public Health, 94(9), 1486-1489. doi:10.2105/ajph.94.9.1486
González, R. C., López, A. M., Rodriguez-Uría, J., Álvarez, D., & Alvarez, J. C. (2010). Real-time gait event detection for normal subjects from lower trunk
accelerations. Gait & Posture, 31(3), 322-325. doi: 10.1016/j.gaitpost.2009.11.014
Guimaraes, R. M., & Isaacs, B. (2009). Characteristics of the gait in old people who fall. International Rehabilitation Medicine, 2(4), 177-180. doi:
10.3109/09638288009163984
Handrigan, G. A., Corbeil, P., Simoneau, M., & Teasdale, N. (2010). Balance control is altered in obese individuals. Journal of Biomechanics, 43(2),
383-384. doi:10.1016/j.jbiomech.2009.08.041
Hausdorff, J. M., Mitchell, S. L., Firtion, R., Peng, C. K., Cudkowicz, M. E., Wei, J. Y., & Goldberger, A. L. (1997). Altered fractal dynamics of gait: reduced
stride-interval correlations with aging and Huntington’s disease. Journal of Applied Physiology, 82(1), 262-269. doi:10.1152/jappl. 1997.82.1.262
Hausdorff, J. M., Rios, D. A., & Edelberg, H. K. (2001). Gait variability and fall risk in community-living older adults: A 1-year prospective study. Archives
of Physical Medicine and Rehabilitation, 82(8), 1050-1056. doi:10.1053/apmr.2001.24893
Hills, A. P., Hennig, E. M., Byrne, N. M., & Steele, J. R. (2002). The biomechanics of adiposity - structural and functional limitations of obesity and
implications for movement. Obesity Reviews, 3(1), 35-43. doi:10.1046/j.1467-789X.2002.00054.x
Hue, O., Simoneau, M., Marcotte, J., Berrigan, F., Doré, J., Marceau, P., . . . Teasdale, N. (2007). Body weight is a strong predictor of postural stability. Gait & Posture, 26(1), 32-38. doi:10.1016/j.gaitpost. 2006.07.005
Hurley, M. V., Rees, J., & Newham, D. J. (1998). Quadriceps function, proprioceptive acuity and functional performance in healthy young, middleaged
and elderly subjects. Age and Ageing, 27(1), 55-62. doi:10.1093/ageing/27.1.55
Imms, F. J., & Edholm, O. G. (1979). Conference on the Ageing Brain. Age and Ageing, 8(4), 261-267. doi: 10.1093/ageing/8.4.261
Jylhava, J., Pedersen, N. L., & Hagg, S. (2017). Biological Age Predictors. EBioMedicine, 21, 29-36. doi: 10.1016/j.ebiom.2017.03.046
Kejonen, P., Kauranen, K., & Vanharanta, H. (2003). The relationship between anthropometric factors and body-balancing movements in postural balance. Archives of Physical Medicine and Rehabilitation, 84(1), 17-22. doi:10.1053/apmr.2003.50058
Kopelman, P. G. (2000). Obesity as a medical problem. N a t u r e , 4 0 4 ( 6 7 7 8 ) , 6 3 5 - 6 4 3 . d o i : 10.1038/35007508
Lajoie, Y., & Gallagher, S. P. (2004). Predicting falls within the elderly community: comparison of postural sway, reaction time, the Berg balance scale and the Activities-specific Balance Confidence (ABC) scale for comparing fallers and non-fallers. Arch Gerontol Geriatr, 38(1), 11-26.
Lockhart, T. E., & Liu, J. (2008). Differentiating fall-prone and healthy adults using local dynamic stability. Erg o n omi c s , 5 1 ( 1 2 ) , 1 8 6 0 - 1 8 7 2 . d o i : 10.1080/00140130802567079
Lockhart, T. E., Soangra, R., Zhang, J., & Wu, X. (2013). Wavelet based automated postural event detection and activity classification with single imu - biomed 2013. Biomed Sci Instrum, 49, 224-233.
Lockhart, T. E., Woldstad, J. C., & Smith, J. L. (2003). Effects of age-related gait changes on the biomechanics of slips and falls. Ergonomics,
4 6 ( 1 2 ) , 1 1 3 6 - 1 1 6 0 . d o i : 10.1080/0014013031000139491
Lowsky, D. J., Olshansky, S. J., Bhattacharya, J., & Goldman, D. P. (2014). Heterogeneity in healthy aging. J Gerontol A Biol Sci Med Sci, 69(6),
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