The effects of adiposity, muscular strength, cardiorespiratory fitness, and fatigue on gait biomechanics in overweight and obese children

Background: Obesity rates continue to increase in the child population. Muscular strength, cardiorespiratory fitness, and fatigue can potentially affect joint stresses in obese children. The purposes are to examine: (1) the relationship between cardiorespiratory fitness and the change in joint stress pre- to post-fatigue; (2) the predictive value of fitness, adiposity, and muscular strength on joint stresses in fatigued and non-fatigued states; and, (3) the relationships between % body fat from skinfold and air displacement plethysmography. Methods: Twenty-seven children, with body mass index above the 85th percentile for their age participated in this study. Lower limb joint moments were recorded before and after a fatiguing Progressive Aerobic Cardiovascular Endurance Run protocol. Linear regression was used to assess the relationship between (1) fitness and change in joint stress pre- to post-fatigue, and (2) measures of %body fat using skinfold and plethysmography. Furthermore, Bland-Altman analysis quantified the agreement between measured adiposity using the two methods. Findings: The strongest relationship was observed between fitness and the change in the knee extensor moment pre- to post-fatigue (R2 = 0.24). Regardless of fatigue state, adiposity and strength were identified as the strongest predictors of joint moments. Skinfold estimates were moderately predictive (R2 = 0.56) of %body fat from air displacement plethysmography, and these two measures demonstrated instrument agreement with no proportional bias. Interpretation: Fitness level is not related to changes in biomechanics pre- to post-fatigue in overweight and obese children. Adiposity and lower extremity strength most strongly influenced joint moments in the frontal and sagittal planes.