Helping Children with Obesity "Move Well" To Move More: An Applied Clinical Review.

ABSTRACT: Children with obesity experience musculoskeletal pain and reduced physical function and well-being, which collectively impact their fitness, strength, motor skills, and even their ability to undertake simple tasks, like walking and climbing stairs. Disrupting obesity-related disability may be critical to increasing children's physical activity. Thus, barriers to movement should be considered by health practitioners to improve the efficacy of prescribed physical activity. This applied clinical review highlights key subjective and objective findings from a hypothetical case scenario, linking those findings to the research evidence, before exploring strategies to enhance movement and increase physical activity.

Age-Related Differences in Perceived Exertion While Walking and Running Near the Preferred Transition Speed.

PURPOSE: To investigate whether youth and adults can perceive differences in exertion between walking and running at speeds near the preferred transition speed (PTS) and if there are age-related differences in these perceptions. METHODS: A total of 49 youth (10-12 y, n = 21; 13-14 y, n = 10; 15-17 y, n = 18) and 13 adults (19-29 y) completed a walk-to-run transition protocol to determine PTS and peak oxygen uptake. The participants walked and ran on a treadmill at 5 speeds (PTS-0.28 m·s-1, PTS-0.14 m·s-1, PTS, PTS+0.14 m·s-1, PTS+0.28 m·s-1) and rated perceived exertion using the OMNI Perceived Exertion (OMNI-RPE) scale. Oxygen consumption was measured during the walk-to-run transition protocol to obtain the relative intensity (percentage of peak oxygen uptake) at PTS. OMNI-RPE scores at all speeds and percentage of peak oxygen uptake at PTS were compared between age groups. RESULTS: The 10- to 12-year-olds transitioned at a higher percentage of peak oxygen uptake than adults (64.54 [10.18] vs 52.22 [11.40], respectively; P = .035). The 10- to 14-year-olds generally reported higher OMNI-RPE scores than the 15- to 17-year-olds and adults (P < .050). In addition, the 10- to 14-year-olds failed to distinguish differences in OMNI-RPE between walking and running at PTS and PTS+0.14 m·s-1. CONCLUSIONS: Children aged 10-14 years are less able to distinguish whether walking or running requires less effort at speeds near the PTS compared with adults. The inability to judge which gait mode is less demanding could hinder the ability to minimize locomotive demands.

Improving Engagement With Biomechanics: Student Perspectives and a Professional Development Initiative.

Student engagement is an essential aspect of educational environments, and this is especially true for Science, Technology, Engineering, and Mathematics (STEM) disciplines, where student engagement declines in middle and high school years. Techniques for bolstering student engagement, such as hands-on learning, may be especially effective in the field of biomechanics since this discipline is rooted in STEM and has fundamental applications to everyday movement. To this end, this paper describes (1) the perceptions of student teachers in their first year of tertiary (undergraduate) education regarding the biomechanics content from their secondary (high school) education, and (2) a professional development initiative, in the form of a discipline-specific teacher training workshop, to enhance biomechanics resources for teachers via peer networking. The perception of student teachers in their first year of tertiary education in teaching indicated a positive relationship between perception of secondary school teaching quality and self-confidence with specific biomechanical concepts. Open responses focused on the need to cover concepts thoroughly, using practical activities where possible, and taking time to ensure understanding before progressing to more advanced concepts. The teacher training workshop provided secondary school Physical Education teachers with an opportunity to network nationally with other teachers across New Zealand, and internationally with university-based biomechanics researchers. Peer focus groups helped to design and refine sets of experiential learning activities that could be easily implemented in the classroom.

Exercise prescription for weight management in obese adults at risk for osteoarthritis: synthesis from a systematic review.

BACKGROUND: The aim of this systematic review was to identify principles of exercise interventions associated with improved physical function, weight management or musculoskeletal pain relief among young and middle-aged adults with obesity and propose an evidence-based exercise prescription that could assist in secondary prevention of osteoarthritis. METHODS: A structured electronic review was conducted using MEDLINE, PubMed, and SPORTDiscus. The search string included 1) "obes*" AND "exercise" AND "interven*" AND "musculoskeletal pain OR knee pain OR hip pain". Studies 1) were randomized controlled trials of humans, with a non-exercise control, 2) included participants aged 18-50 years, and 3) had outcomes that included physical function, musculoskeletal pain, and/or body composition. Studies were excluded if participants had peri-menopausal status, cancer, or obesity-related co-morbidities. A recommended exercise prescription was developed based on common principles used in the included exercise interventions with greatest change in function or pain. RESULTS: Seven studies were included. Similarities in exercise intensity (40-80% VO2max), frequency (three times per week), duration (30-60 min), and exercise mode (treadmill, cross-trainer, stationary bike, aquatic exercise) were observed in exercise interventions that resulted in improved physical function and/or pain, compared to non-exercise control groups. CONCLUSION: Common principles in exercise prescription for improvements in weight management, physical function and pain relief among otherwise healthy people with obesity. Exercise prescription including moderate intensity exercise for 30-60 min, three times per week can be considered an effective treatment for weight management and obesity-related musculoskeletal symptoms. Exercise should be recommended to at-risk individuals as part of secondary prevention of osteoarthritis.

Stationary Exercise in Overweight and Normal Weight Children.

PURPOSE: This study examined differences in lower extremity kinematics and muscle activation patterns between normal weight (NW) and overweight (OW) children during stationary exercises (running in place, frontal kick, and butt kick) at submaximal intensity. METHODS: Healthy children (aged 10-13 y) were stratified into OW (n = 10; body fat percentage: 34.97 [8.60]) and NW (n = 15; body fat percentage: 18.33 [4.87]). Electromyography was recorded for rectus femoris, vastus lateralis, biceps femoris, gastrocnemius, and tibialis anterior. In addition, the ratings of perceived exertion and range of motion of hip, knee, and ankle joints were collected during stationary exercises. Repeated-measures analysis of variance compared muscle activation, range of motion, and ratings of perceived exertion between groups and exercises. Friedman test examined sequencing of muscles recruitment. RESULTS: Compared with NW, OW experienced significantly greater ratings of perceived exertion (13.7 [0.8] vs 11.7 [0.7]; P < .001) and electromyography amplitude in all muscles apart from vastus lateralis during stationary exercises. In addition, NW children used more consistent muscles' recruitment pattern in comparison with OW children. The range of motion was similar between groups at all joints. CONCLUSION: OW children may adopt a more active neuromuscular strategy to provide greater stability and propulsion during stationary exercises. Stationary exercise can be prescribed to strengthen lower extremity muscles in OW children, but mode and intensity must be considered.

Kinematic Comparison of Aquatic- and Land-Based Stationary Exercises in Overweight and Normal Weight Children.

PURPOSE: This study examined lower extremity kinematics in healthy weight (HW) and overweight (OW) children during water- and land-based stationary exercises (stationary running, frontal kick, and butt kick) at light submaximal intensity. METHODS: Participants included OW (N = 10; body fat percentage: 34.97 [8.60]) and HW (N = 15; body fat percentage: 18.33 [4.87]) children, aged 10 to 13 years. Spatiotemporal data, lower extremity joint kinematics, and rating of perceived exertion (RPE) were collected during water- and land-based stationary exercises. Repeated measures analysis of variance compared kinematic variables and RPE between groups and environments. A polygon area function compared coordination patterns between environments. RESULTS: RPE responses were significantly greater in OW than HW children on land (13.6 [0.7] vs 11.6 [0.7]; P < .001), whereas the RPE responses were similar between groups in water (11.2 [0.7] vs 11.1 [0.8]; P > .05). OW children were significantly more upright than HW children during land-based exercise, whereas there were no differences observed between groups during aquatic-based exercise. The duration of stance and swing phases, angular velocity, and cadence were significantly lower in water than on land. CONCLUSION: Compared with HW children, OW children performed stationary exercises in a more upright posture on land, with higher RPE. However, these differences diminished in water. Aquatic-based exercise may be effective in minimizing the effects of excess mass on OW children's ability to complete physical activity.

An Investigation of Structure, Flexibility, and Function Variables that Discriminate Asymptomatic Foot Types.

It has been suggested that foot type considers not only foot structure (high, normal, low arch), but also function (overpronation, normal, oversupination) and flexibility (reduced, normal, excessive). Therefore, this study used canonical regression analyses to assess which variables of foot structure, function, and flexibility can accurately discriminate between clinical foot type classifications. The feet of 61 asymptomatic, healthy adults (18-77 years) were classified as cavus (N = 24), rectus (N = 54), or planus (N = 44) using standard clinical measures. Custom jigs assessed foot structure and flexibility. Foot function was assessed using an emed-x plantar pressure measuring device. Canonical regression analyses were applied separately to extract essential structure, flexibility, and function variables. A third canonical regression analysis was performed on the extracted variables to identify a combined model. The initial combined model included 30 extracted variables; however 5 terminal variables (malleolar valgus index, arch height index while sitting, first metatarsophalangeal joint laxity while standing, pressure-time integral and maximum contact area of medial arch) were able to correctly predict 80.7% of foot types. These remaining variables focused on specific foot characteristics (hindfoot alignment, arch height, midfoot mechanics, Windlass mechanism) that could be essential to discriminating foot type.

"Where Does it Hurt?" Implications of Obesity on Musculoskeletal Health.

Obesity and musculoskeletal health are inextricably linked across risk factors, prevalence rates, and societal burden. They are also linked across management strategies. It is necessary to consider the mutual impact of musculoskeletal health and obesity in order to inform effective and safe weight management and physical activity solutions.

Comparative electromyography analysis of the upper extremity between inexperienced and elite water polo players during an overhead shot.

The aim of this study was to compare muscle activity patterns between inexperienced and experienced water polo players while taking an overhead shot. The study was carried out with a group of 12 water polo players and an inexperienced group of 10 healthy participants. Signals were recorded by surface electromyography from six different muscles. The average and standard deviation of the normalized electrical activity, time to peak, time broadness, and muscle sequencing during the overhead shot were determined for each muscle in both groups and compared with each other. In water polo players, the normalized electrical activities of triceps brachii, pectoralis major, and wrist flexors were greater than other muscles, while in the inexperienced group the triceps brachii specifically played an important role. There was minimal activation of the middle deltoid and biceps brachii in water polo players. Increased times to peak and time broadness of muscles were found in the inexperienced group compared to experienced water polo players; this difference may be explained by different neuromuscular proprioception. Only experienced water polo players activated the observed muscles in a specific sequence, from proximal to distal. Therefore, coaches should emphasize smooth and quick transitions from proximal to distal segments, with less importance placed on individual muscle strengthening.

A boxing-oriented exercise intervention for obese adolescent males: findings from a pilot study.

In New Zealand, obese Maori and Pasifika adolescents are at risk of numerous cardio-metabolic conditions with raising physical activity levels being proposed as a useful intervention. The present study used a mixed method design to explore the effects of a non-contact boxing-oriented training programme designed in terms of improvements to cardio-metabolic variables. Traditional recruitment strategies (media, referrals) were employed, with limited success leading to 3 adolescent boys (14-15 y) participating in the pilot intervention. Exercise sessions included 30 minutes of non-contact boxing training, followed by 30 minutes of progressive resistance training. Participants attended three 1h training sessions each week, for a total of 12 weeks. Physiological variables included anthropometric indices, visceral fat thickness, central blood pressures, central arterial stiffness (augmentation index: AIx), and carotid arterial stiffness (ß). Results revealed that there was no trend for change in body weight (125.5 ± 12.1 kg vs. 126.5 ± 11.0 kg) or BMI (39.3 ± 4.1 kg·m(-2) vs. 39.0 ± 4.6 kg·m(-2)). However, there was a moderate decrease in visceral fat thickness (4.34 ± 2.51 cm vs 3.65 ± 1.11 cm, d = 0.36). There was no change in central pulse pressure (38.7 ± 7.3 mmHg vs. 38.3 ± 5.0 mmHg), however, there was a small improvement in ß (3.01 ± 0.73 vs. 2.87 ± 0.84, d = 0.18). Focus group interview data with participants and their parents were used to explore issues related to motivation to participation. Results revealed participants commented on how the programme has led to new friendships, changes to their physical appearance, and increased physical fitness. Parents commented on increased self-confidence, better performance in school, and a willingness to take part in new activities. In conclusion, it appears participating in the boxing oriented training programme was motivating to participants who engaged and had some physiological benefits in obese adolescent boys of Maori and Pasifika descent. However, despite these positive attributes, poor recruitment rates suggest that future work should focus on identifying the barriers to engagement. Key pointsA boxing-oriented intervention was developed for use with Maori and Pasifika adolescents to improve cardiometabolic risk factors.While results indicate positive benefits of participation in the 60-minute boxing-orientated programme, only three participants were recruited despite intense promotion.Future research should investigate the efficacy of strategies designed to raise intentions to exercise.

Differences in segmental fat accumulation patterns by sex and ethnicity: An international approach.

Excess fat on the body impacts obesity-related co-morbidity risk; however, the location of fat stores affects the severity of these risks. The purpose of this study was to examine segmental fat accumulation patterns by sex and ethnicity using international datasets. An amalgamated and cross-calibrated dataset of dual x-ray absorptiometry (DXA)-measured variables compiled segmental mass for bone mineral content (BMC), lean mass (LM), and fat mass (FM) for each participant; percentage of segment fat (PSF) was calculated as PSFsegment = (FMsegment/(BMCsegment + LMsegment + FMsegment)) × 100. A total of 30 587 adults (N = 16 490 females) from 13 datasets were included. A regression model was used to examine differences in regional fat mass and PSF. All populations followed the same segmental fat mass accumulation in the ascending order with statistical significance (arms < legs < trunk), except for Hispanic/Latinx males (arms < [legs = trunk]). Relative fat accumulation patterns differed between those with greater PSF in the appendages (Arab, Mexican, Asian, Black, American Caucasian, European Caucasian, and Australasian Caucasian females; Black males) and those with greater PSF in the trunk (Mexican, Asian, American Caucasian, European Caucasian, and Australasian Caucasian males). Greater absolute and relative fat accumulation in the trunk could place males of most ethnicities in this study at a higher risk of visceral fat deposition and associated co-morbidities.

Exercise modality and metabolic efficiency in children.

UNLABELLED: Current exercise prescription guidelines for children recommend at least 60 min of moderate-to-vigorous physical activity every day. However, little is known about the efficacy of different cardiorespiratory exercise modalities prescribed to the pediatric cohort. Sixteen healthy children (8-12 years) completed 5-min trials of treadmill walking, cycling, and elliptical training in a randomized order. The treadmill walking speed was determined from measurements collected during a self-selected walking trial. The workloads for treadmill walking, cycling, and elliptical training were matched (40.3 W). Mechanical efficiency (ME%), perceived exertion (RPE), oxygen uptake, metabolic equivalents, and net energy expenditure were measured. ME% in walking was significantly higher than in cycling (P = 0.001) and elliptical training (P < 0.001), and cycling was significantly higher than elliptical training (P = 0.003). RPE in walking was significantly lower than in elliptical training (P = 0.006) but not from cycling (P = 0.314), and cycling resulted in significantly lower RPE than elliptical training (P = 0.021). CONCLUSION: Treadmill walking appears to be the most efficacious exercise prescription for otherwise healthy children; however, longitudinal studies need to be implemented to investigate the long-term benefits of each exercise modality.

Let's go! The impact of mobile laboratory technology on STEM accessibility during National Biomechanics Day.

National Biomechanics Day continues to expose thousands of youth to the biomechanics discipline each year. As part of the 2022 events, Seattle University used its Kinesiology Mobile Lab to host multiple National Biomechanics Day events across Washington state, engaging over 600 youth in a one-month period. This case study in hands-on experiential learning highlights the use of on-site demonstrations to increase accessibility to STEM education and educational resources.

Using a modified vector coding technique to describe the calcaneus-shank coupling relationship during unanticipated changes of direction: theoretical implications for prophylactic ACL strategies.

Shank rotation is associated with increased risk in lower limb injuries of weight-bearing sport activity. Straight-line running injury prevention research proposes a 'bottom-up' approach to minimising injury risk to the knee. This prophylactic recommendation is due to the observed distal-proximal coupling relationship between rearfoot and shank rotations. However, the coupling relationship between the calcaneus and shank is unknown in sports with high intensity decelerations, frequent changes of direction, associated with increased anterior cruciate ligament (ACL) injury risk. The aim of this study was to determine whether the movement of the calcaneus has a potential effect on the internal and external rotational movement of the shank, associated with ACL injury risk. We implemented a modified vector coding technique using segmental velocities in a local, anatomical reference frame to quantify the coupling relationship between the individual tri-planar calcaneus rotations and transverse plane shank rotations. During the loading phase, a distal-proximal coupling relationship between calcaneus eversion deceleration, abduction acceleration, and shank internal rotation deceleration was observed amongst most subjects. The distal-proximal coupling found between the calcaneus and shank justifies exploring interventions geared towards manipulating calcaneus motion to affect shank rotational movements during unanticipated change of direction tasks associated with ACL injury risk.

Evidence-Based Dietary Practices to Improve Osteoarthritis Symptoms: An Umbrella Review.

While there is some research investigating whole foods or diets that are easily understood and accessible to patients with osteoarthritis, specific nutrients or nutraceuticals are more commonly identified. Unfortunately, guidelines and evidence surrounding individual nutrients, extracts, and nutraceuticals are conflicting and are more difficult to interpret and implement for patients with osteoarthritis. The purpose of this umbrella review is to provide a comprehensive understanding of the existing evidence of whole foods and dietary patterns effects on osteoarthritis-related outcomes to inform evidence-based recommendations for healthcare professionals and identify areas where more research is warranted. A literature search identified relevant systematic reviews/meta-analyses using five databases from inception to May 2022. Five systematic reviews/meta-analyses were included in the current umbrella review. Most evidence supported the Mediterranean diet improving osteoarthritis-related outcomes (e.g., pain, stiffness, inflammation, biomarkers of cartilage degeneration). There was little to no evidence supporting the effects of fruits and herbs on osteoarthritis-related outcomes; however, there was some suggestion that specific foods could potentiate symptom improvement through antioxidative mechanisms. The overall lack of homogeneity between the studies limits the conclusions that can be made and highlights the need for quality research that can identify consumer-accessible foods to improve osteoarthritis-related symptoms.

Body mass affects kinetic symmetry and inflammatory markers in adolescent knees during gait.

BACKGROUND: Early-onset osteoarthritis has been attributed to pro-inflammatory factors and biomechanical changes in obesity. However, research has yet to explore whether knee joint moments are asymmetrical in children with obesity and could precede the onset of knee osteoarthritis. The present study compares knee moment asymmetry between adolescents with and without obesity and examines the relationship between asymmetries and inflammatory biomarkers. METHODS: Twenty-eight adolescents (13-16 years) were classified as with (n = 12) or without (n = 16) obesity. Lower extremity kinetics were measured using three-dimensional motion analysis. Bilateral knee joint moments were analyzed in the sagittal, frontal, and transverse planes across stance phase. Kinetic asymmetry was calculated between the right and left sides and represented by the R2 value. Enzyme-linked immunosorbent assays analyzed serum 25-hydroxy vitamin D, interferon gamma, tumor nercrosis factor alpha, interleukin-6, and C-reactive protein levels. Parametric and non-parametric tests determined significant group differences in asymmetries and biomarkers, respectively. Spearman's correlations identified relationships between biomarkers and asymmetries with statistically significant group differences. FINDINGS: Adolescents with obesity had greater sagittal (loading, midstance) and frontal (midstance, pre-swing) plane kinetic knee asymmetry and higher concentrations of interleukin-6 and C-reactive protein. A moderately negative correlation existed between C-reactive protein and sagittal (loading, midstance) plane asymmetry, and also between interleukin-6 and frontal (pre-swing) plane asymmetry. INTERPRETATION: Inflammatory response increases with greater knee joint asymmetry, suggesting knee joint damage and altered joint loading co-exist in adolescents with obesity. Increased risk to joint health may exist in sub-phases where knee joints are improperly loaded.

Replacing Sedentary Time with Physically Active Behaviour Predicts Improved Body Composition and Metabolic Health Outcomes.

BACKGROUND: Discretionary leisure time for health-promoting physical activity (PA) is limited. This study aimed to predict body composition and metabolic health marker changes from PA reallocation using isotemporal substitution analysis. METHODS: Healthy New Zealand women (n = 175; 16-45 y) with high BMI (≥25 kg/m2) and high body fat percentage (≥30%) were divided into three groups by ethnicity (Maori n = 37, Pacific n = 54, and New Zealand European n = 84). PA, fat mass, lean mass, and metabolic health were assessed. Isotemporal substitution paradigms reallocated 30 min/day of sedentary behaviour to varying PA intensities. RESULTS: Reallocating sedentary behaviour with moderate intensity, PA predicted Maori women would have improved body fat% (14.83%), android fat% (10.74%), and insulin levels (55.27%) while the model predicted Pacific women would have improved waist-to-hip (6.40%) and android-to-gynoid (19.48%) ratios. Replacing sedentary time with moderate-vigorous PA predicted Maori women to have improved BMI (15.33%), waist circumference (9.98%), body fat% (16.16%), android fat% (12.54%), gynoid fat% (10.04%), insulin (55.58%), and leptin (43.86%) levels; for Pacific women, improvement of waist-to-hip-ratio (5.30%) was predicted. CONCLUSIONS: Sedentary behaviour must be substituted with PA of at least moderate intensity to reap benefits. Maori women received the greatest benefits when reallocating PA. PA recommendations to improve health should reflect the needs and current activity levels of specific populations.

Mind the Gap: Exploring Nutritional Health Compared With Weight Management Interests of Individuals with Osteoarthritis.

Background: For persons with osteoarthritis (OA), nutrition education may facilitate weight and OA symptom management. Objectives: The primary aim of this study was to determine preferred OA-related nutritional and weight management topics and their preferred delivery modality. The secondary aim was to determine whether there is a disconnect between what patients want to know about nutrition and OA management and what information health-care professionals (HCPs) are providing to patients. Methods: The Osteoarthritis Action Alliance surveyed individuals with OA to identify their preferences, categorized in 4 domains: 1) strategies for weight management and a healthy lifestyle; 2) vitamins, minerals, and other supplements; 3) foods or nutrients that may reduce inflammation; and 4) diets for weight loss. HCPs were provided these domains and asked which topics they discussed with patients with OA. Both groups were asked to select currently utilized or preferred formats of nutritional resources. Results: Survey responses from 338 individuals with OA and 104 HCPs were included. The highest preference rankings in each domain were: 1) foods that make OA symptoms worse (65%), foods and nutrients to reduce inflammation (57%), and healthy weight loss (42%); 2) glucosamine (53%), vitamin D (49%), and omega-3 fatty acids (45%); 3) spices and herbs (65%), fruits and vegetables (58%), and nuts (40%); and 4) Mediterranean diet (21%), low-carbohydrate diet (18%), and fasting or intermittent fasting (15%). There was greater than 20% discrepancy between interests reported by individuals with OA and discussions reported by HCPs on: weight loss strategies, general information on vitamins and minerals, special dietary considerations for other conditions, mindful eating, controlling caloric intake or portion sizes, and what foods worsen OA symptoms. Most respondents preferred to receive nutrition information in a passive format and did not want information from social media messaging. Conclusions: There is disparity between the nutrition education content preferred by individuals with OA (which often lacks empirical support) and evidence-based topics being discussed by HCPs. HCPs must communicate evidence-based management of joint health and OA symptoms in patient-preferred formats. This study explored the information gap between what individuals with OA want to know and what HCPs believe they need to know.

Mini-Trampoline Jumping as an Exercise Intervention in Postmenopausal Women to Improve Women Specific Health Risk Factors.

BACKGROUND: Women tend to outlive men and are at higher risks of functional disability compared to men. Specifically, women are more likely to develop conditions like osteoporosis and stress urinary incontinence which can further increase the risk of functional disability. Regular physical activity and/or exercise programs can minimize the physiological decline that occurs during aging and can improve overall physical fitness, bone health, and pelvic floor muscle function; however, exercise programs tend to focus on only one parameter. Mini-trampoline jumping is a highly beneficial low-impact aerobic exercise capable of improving aerobic fitness, balance, muscle strength, and potentially bone health as well as pelvic floor muscle functioning. The aim of the proposed research project is to examine the benefits of a 3-month mini-trampoline exercise intervention on physical fitness, bone health, and pelvic floor muscle functioning in postmenopausal women. METHODS: Fifty postmenopausal healthy women aged 50-69 years will be recruited. Assessments on physical fitness (aerobic fitness, walking speed, balance, lower extremity strength, flexibility), bone health, and pelvic floor muscle functioning will occur within 1 week before and after the exercise intervention, including a 3-month follow-up assessment. The exercise intervention will last 12 weeks, with three sessions of 40 min each per week. CONCLUSIONS: The proposed research has the potential to improve functional ability and women-specific risk factors in older women with an innovative and fun exercise program.

Neuromusculoskeletal Health in Pediatric Obesity: Incorporating Evidence into Clinical Examination.

PURPOSE OF REVIEW: The study aims to highlight the clinical importance of assessing and managing neuromusculoskeletal health in pediatric obesity and to support translation of evidence into practice. RECENT FINDINGS: A growing evidence base suggests that children with obesity experience neuromusculoskeletal impairments and physical complications including increased pain, reduced muscle strength, impaired balance and motor skill, gait deviations, postural malalignment, greater fatigue, and potentially reduced flexibility and sub-optimal bone health. Such evidence supports the need to screen, assess, and optimize neuromusculoskeletal health as part of pediatric obesity management. The likelihood of children with obesity experiencing neuromusculoskeletal impairments is high and can impact the way a child moves, and their interest or capacity to engage in physical activity and exercise. Barriers to movement should be minimized to promote optimal development of the neuromusculoskeletal system and to support engagement in sufficient physical activity for weight management. Healthcare professionals should screen for neuromusculoskeletal impairments as well as personalize interventions and modify standardized exercise interventions to optimize obesity treatment. Further research should explore whether neuromusculoskeletal impairments influence the success of obesity treatment or whether they improve following obesity treatment.