DE-PASS Best Evidence Statement (BESt): modifiable determinants of physical activity and sedentary behaviour in children and adolescents aged 5-19 years-a protocol for systematic review and meta-analysis.

INTRODUCTION: Physical activity among children and adolescents remains insufficient, despite the substantial efforts made by researchers and policymakers. Identifying and furthering our understanding of potential modifiable determinants of physical activity behaviour (PAB) and sedentary behaviour (SB) is crucial for the development of interventions that promote a shift from SB to PAB. The current protocol details the process through which a series of systematic literature reviews and meta-analyses (MAs) will be conducted to produce a best-evidence statement (BESt) and inform policymakers. The overall aim is to identify modifiable determinants that are associated with changes in PAB and SB in children and adolescents (aged 5-19 years) and to quantify their effect on, or association with, PAB/SB. METHODS AND ANALYSIS: A search will be performed in MEDLINE, SportDiscus, Web of Science, PsychINFO and Cochrane Central Register of Controlled Trials. Randomised controlled trials (RCTs) and controlled trials (CTs) that investigate the effect of interventions on PAB/SB and longitudinal studies that investigate the associations between modifiable determinants and PAB/SB at multiple time points will be sought. Risk of bias assessments will be performed using adapted versions of Cochrane's RoB V.2.0 and ROBINS-I tools for RCTs and CTs, respectively, and an adapted version of the National Institute of Health's tool for longitudinal studies. Data will be synthesised narratively and, where possible, MAs will be performed using frequentist and Bayesian statistics. Modifiable determinants will be discussed considering the settings in which they were investigated and the PAB/SB measurement methods used. ETHICS AND DISSEMINATION: No ethical approval is needed as no primary data will be collected. The findings will be disseminated in peer-reviewed publications and academic conferences where possible. The BESt will also be shared with policy makers within the DE-PASS consortium in the first instance. SYSTEMATIC REVIEW REGISTRATION: CRD42021282874.

The effect of body mass reduction on functional stability in young obese women.

Functional stability is necessary for everyday activities. The studies have indicated the deterioration of functional stability during standing in the obese adults. This study aimed to determine whether the 3-month weight-loss program that resulted in body mass reduction equal to or greater than 5% of the initial body mass would improve functional stability in young obese women. For the purpose of this study, the data of 30 females were included. Their mean age was 35.8 ± 9.2. The women performed the anterior limit of stability test on the force platform twice: before and after weight-loss program. Their BMI at two sessions was 36.1 ± 5.1 and 32.3 ± 5, respectively. After the weight loss program, the COP velocities were increased in both phases of the anterior limit of stability test: the dynamic transition from standing to maximal forward-leaning and the maintenance of maximal forward-leaning position (p < 0.05). No significant changes in the values of the COP parameters were found in the eyes-closed trial (p > 0.05). The results suggest that body mass reduction in young obese women led to improved mobility and postural control when visual cuing was available. The longer-lasting weight-loss program might be necessary to observe this effect under visual deprivation conditions. Body mass should be reduced in obese patients to improve their mobility and functional stability; it may prevent unexpected falls.

New methods of posturographic data analysis may improve the diagnostic value of static posturography in multiple sclerosis.

BACKGROUND: Early and accurate diagnosis of multiple sclerosis (MS) is crucial for its effective treatment. In MS diagnostic, neuronal networks that control posture and movement are of particular importance, which performance can be assessed using static posturography. Unfortunately, most of the commercially available posturographic platforms are not equipped with the appropriate procedures. METHODS: To solve this problem, the postural sway trajectories have been recorded in 55 MS patients while standing quiet with eyes open (EO), and then with eyes closed (EC). The trajectories were analyzed using our novel methods of postural sway parametrization, including sway stability vector (SV), anteroposterior and mediolateral sway indices (DIAP and DIML). RESULTS: The results exhibited unique postural sway patterns that may be attributed to MS. Our novel parametrization methods of postural sway showed pathology specific increase of the postural sway velocity in EC tests. Additionally, we documented the abnormal alterations of the anteroposterior (AP) and the mediolateral (ML) sway indices that were also uniquely dependent on visual input. In EC tests, patients exhibited a characteristic pattern of sway increase in both AP and ML directions that correlated with the advance of the disease as measured by the EDSS Kurtzke scale and Functional System Scores. CONCLUSIONS: The applied in the present study our novel posturographic metrics give the assessment a diagnostic value. It allows us to recommend the static posturography test as a simple and safe supplementary clinical tool in the diagnosis of MS. In the assessment of MS pathology or the effects of its treatment, the impact of vision on the sway stability vector seems the most important factor.

A prospective longitudinal comparison of the sacral inclination angle in women between their early and advanced pregnancy and 6-month postpartum follow-up.

PURPOSE: The impact of pregnancy on the anterior-posterior sacral orientation and its relation to lumbopelvic pain and weight gain has not been fully recognized. This longitudinal study aimed to compare the sacral inclination angle in women between their early and advanced pregnancy and at 6 months postpartum. The authors also searched for a correlation between the sacral inclination and lumbopelvic pain, BMI and change in body mass. METHODS: Thirteen healthy women participated in the study. Data were collected at 8-16 and 35-38 weeks of gestation, and at 27-31.5 postpartum weeks. At each session, the women's sacral inclination angles were measured using the Saunders digital inclinometer. Data were also collected on lumbopelvic pain, BMI and body mass gain/loss. RESULTS: There was no effect of the evaluation period on the sacral inclination (p > 0.05); however, various individual values of the sacral inclination in pregnancy and postpartum were noted. In advanced pregnancy, 61.5% of the women had recurrent pain in the lumbopelvic region. The sacral inclination did not correlate with the lumbopelvic pain, BMI and body mass change (p > 0.05) in the pregnancy and postpartum periods. CONCLUSIONS: Advanced pregnancy did not influence sacral inclination. However, individuals varied in their responses. Therefore, we suggest that an individually-based physical therapy approach concerning proper posture during and after pregnancy should be emphasized. The sacral inclination had no impact on the occurrence of recurrent lumbopelvic pain. BMI and changes in body mass did not influence the sacral inclination in advanced pregnancy and at 6 months postpartum.

Posturographic characteristics of the standing posture and the effects of the treatment of obesity on obese young women.

To determine the impact of body weight on quiet standing postural sway characteristics in young women, this research compared spontaneous oscillations of the center of foot pressure (COP) between 32 obese (BMI: 36.4 ± 5.2 kg/m2), and 26 normal-weight (BMI: 21.4 ± 1.5 kg/m2) women and assessed the influence of obesity treatment and body weight reduction on postural sway. Trajectories of the COP were assessed while the subjects were standing quietly with eyes open (EO) and closed (EC). Both in the sagittal (AP) and frontal (ML) planes the sway range, average velocity, and maximal velocity of COP were calculated. Moreover, the total average and maximal velocities were computed. In the obese group, the tests were performed twice-before and after the obesity treatment. A greater (18% in EC) AP sway range and a substantial reduction of ML sway (25% in EO, 22% in EC) were observed in the obese women. The total COP velocities (average and maximal) were decreased in obese women (20% and 20% in EO) as well as the velocities in the frontal plane (EO: 33%, 41%; EC: 34%, 40%). Body weight reduction resulted in significant changes in postural sway. The following parameters increased: ML sway range (28% in EO), average (20% in EO, 16% in EC) and maximal ML (20% in EO) velocities. The results indicate that young obese women in the habitual standing position are characterized by the destabilizing influence of mass in the sagittal plane only in the absence of a visual control. This effect is dominated by the stabilizing mass effect in the frontal plane, which affects overall postural stability when standing. The reduction of body mass enables a decrease in ML static stability, likely due to natural changes in the base of support while standing.

Trunk forward flexion mobility in reference to postural sway in women after delivery: A prospective longitudinal comparison between early pregnancy and 2- and 6-month postpartum follow-ups.

BACKGROUND: It has been documented that pregnancy-related increased connective tissue laxity may persist postpartum; however, it is still unclear for how long. This longitudinal study aimed to compare total trunk forward flexion mobility in women between their first trimester of pregnancy and at 2- and 6-month postpartum follow-ups. We also searched for a correlation between women's trunk flexibility and their postural stability in the sagittal plane. METHODS: Seventeen healthy women participated in the study. Data were collected at their 7-12 weeks gestation appointments and at 6-10 and 25-28 weeks postpartum. At each session, the women performed a finger floor distance test, and data were collected on their waist circumference and BMI. The women's center of foot pressure mean velocity in the anterior-posterior direction was computed from 30-s long quiet-standing trials on a stationary force plate. FINDINGS: Total trunk forward flexion mobility was significantly higher at 2 and 6 months postpartum compared to that in early pregnancy (P < 0.05). At 6 months postpartum, a moderate negative correlation between finger floor distance test values and their anterior-posterior center of foot pressure mean velocity was observed (r = -0.6, P < 0.05). INTERPRETATION: Increased total trunk flexibility may be present in women 6 months postpartum. During that period, women with higher trunk flexibility may be more likely to present higher anterior-posterior postural sway velocity in quiet standing.

The influence of adipose tissue location on postural control.

A growing body of evidence suggests, that excessive body weight is inseparably connected with postural instability. In none of previous studies, body weight distribution has been considered as a factor, which may affect results of a static posturography. The purpose of the present study is to quantify some center of foot pressure (COP) characteristics in 40 obese women with android type of obesity (waist-to-hip ratio - WHR≥0.85, BMI: 37.5±5.4) and 40 obese women with gynoid type of obesity (WHR<0.85, BMI: 36.9±5.1). Variables of postural sway were acquired while subjects were standing quietly on a force plate with eyes open and closed. Both in the sagittal and frontal plane sway range, average velocity, and maximal velocity of COP were calculated. Moreover, the total average velocity and total maximal velocity of the COP displacement were computed. Women with abdominal obesity showed a larger sway range in the anterior-posterior plane with eyes open (p<0.0282) and eyes closed conditions (p<0.0115) and a greater maximal COP velocity to compare with subjects with gynoidal obese type (p<0.0112) with eyes closed condition. The postural stability in obese women from the biomechanical point of view is strongly dependent on body distribution. Women with the abdominal obesity type may be exposed to a greater risk of postural instability as compare to women with gynoid fat distribution.

Static Postural Stability in Women during and after Pregnancy: A Prospective Longitudinal Study.

This longitudinal study aimed to compare static postural stability in women between early pregnancy, advanced pregnancy, and at 2 and 6 months postpartum. Forty-five pregnant women were enrolled and 31 completed the protocol. Data were collected at 7-16 and 34-39 weeks gestation, and at 6-10 and 26-30 weeks postpartum. For each subject, the center of foot pressure path length and mean velocity (with directional subcomponents) were computed from 30-s long quiet-standing trials on a stationary force plate with eyes open or closed. The body mass, stance width, and sleep duration within 24 h before testing were also recorded. Static postural stability was not different between pregnancy and postpartum, except for the anterior posterior sway tested in the eyes-closed condition, which was significantly increased in late pregnancy compared to that at 2 and 6 months postpartum. Pregnant/postpartum women's body mass weakly positively correlated with anterior-posterior sway in the eyes-closed condition and their stance width weakly positively correlated with the anterior-posterior sway in the eyes-open condition. No effect of sleep duration on postural sway was found. Our findings indicate that under visual deprivation conditions women in advanced pregnancy may have decreased static stability compared to their non-pregnant state.

Comparison of static postural stability in exercising and non-exercising women during the perinatal period.

BACKGROUND: The purpose of the study was to determine whether women who exercised during and after pregnancy had better static postural stability compared to those who did not exercise. MATERIAL AND METHODS: Posturographic tests were performed in 31 women at 34-39 weeks gestation, and again at 6-10 weeks postpartum. The center of pressure mean velocity (with directional subcomponents) and sway area were computed from 30-s quiet standing trials on a stationary force plate with eyes open or closed. The women were surveyed about their lifestyle and physical activity in the perinatal period. Based on the survey, 12 of the women were assigned as regular exercisers and 19 as non-exercisers. A Mann-Whitney U test was used to compare data of the exercisers and the non-exercisers in their advanced pregnancy and again at 2 months postpartum. RESULTS: Postural sway measures were not significantly different between the exercisers and the non-exercisers in advanced pregnancy and at 2 months postpartum (p>0.05). CONCLUSIONS: Individually performed physical activity during the perinatal period did not affect pregnant/postpartum women's postural stability characteristics of quiet standing.

Impact of excess body weight on walking at the preferred speed.

The implications of a long-lasting mechanical load on the locomotor activity are poorly understood. The objective of the present studies was to determine an impact of excess body weight on basic spatiotemporal gait measures and to test the hypothesis that leg swing phase may account for a load-related adaptation of the stride characteristics. To this end the basic spatial and temporal stride measures were assessed in 100 obese and 36 lean women (age range between 18 and 67 years) walking with their self-selected pace on a 10-meter long and 1 meter wide instrumented pathway. Among the subjects there were: 44 with class I obesity, 27 with class II obesity, and 29 with class III. Subjects' stance and swing times as well as the stride lengths were recorded by means of contact copper-film electrodes attached to a sole of subject' footwear. The acquired gait measures were used then to compute: a mean velocity of walking, double support times and a mean velocity of a foot during swing phase. Data analysis showed that subjects from every experimental groups walked with a very similar speed (1.08 +/- 0.2 m/s) and cadence (106 +/- 10 steps/min). Their stance time was not affected by body weight and it remained at the mean level of 746 +/- 90 ms for all groups. The temporal stride characteristics and the stance-to-swing ratio were, however, substantially modified in obese individuals due to attenuation of the swing time. As a consequence, the remaining normalized (i.e., expressed as percentage of gait cycle time) phases of stride: the stance and the double support were relatively longer. While the swing time negatively correlated with the body mass index (BMI), the normalized stance and the double support exhibited strong positive correlation (r=0.46) with the BMI. The increase of leg swing velocity seems the main and unique adaptation mechanism that is utilized in the preferred walking gait in obese women.

Effects of excessive body weight on postural control.

Research that evaluated both static and dynamic stability was performed, to clarify the impact of excessive body weight on postural control. The spontaneous center of foot pressure (CP) motion during quiet stance and a range of forward voluntary CP displacements were studied in 100 obese, and 33 lean women. Characteristics of postural sway were acquired while the subjects were standing quiet on a force plate with eyes open (EO) and with eyes closed (EC). Their anterior range of CP voluntary displacements was assessed upon a range of maximal whole body leanings which were directed forward. A substantial reduction of postural sway was observed in all patients which had increased body weight. Main postural sway parameters i.e., the total path length as well as its directional components were negatively correlated with the body mass and body mass index (BMI). The range of a whole body voluntary forward leaning, did not exhibit any significant change in patients with an obesity grade of I and II. Such a deficit was, however, found in subjects with a body mass index above 40. In conclusion, the increased body weight imposed new biomechanical constraints, that resulted in functional adaptation of the control of the erect posture. This functional adaptation was characterized by a reduced postural sway associated with a substantial reduction of the dynamic stability range in subjects with BMI>40.