Stair climbing results in more challenging patellofemoral contact mechanics and kinematics than walking at early knee flexion under physiological-like quadriceps loading

The mechanical environment during stair climbing has been associated with patellofemoral pain, but the contribution of loading to this condition is not clearly understood. It was hypothesized that the loading conditions during stair climbing induce higher patellofemoral pressures, a more lateral force distribution on the trochlea and a more lateral shift and tilt of the patella compared to walking at early knee flexion. Optical markers for kinematic measurements were attached to eight cadaveric knees, which were loaded with muscle forces at instances of walking and stair climbing cycles at 12° and 30° knee flexion. Contact mechanics were determined using a pressure sensitive film. At 12° knee flexion, stair climbing loads resulted in higher peak pressure (p=0.012) than walking, more lateral force distribution (p=0.012) and more lateral tilt (p=0.012), whilst mean pressure (p=0.069) and contact area (p=0.123) were not significantly different. At 30° knee flexion, although stair climbing compared to walking loads resulted in significantly higher patellofemoral mean (p=0.012) and peak pressures (p=0.012), contact area (p=0.025), as well as tilt (p=0.017), the medial–lateral force distribution (p=0.674) was not significantly different. No significant differences were observed in patellar shift between walking and stair climbing at either 12° (p=0.093) or 30° (p=0.575) knee flexion. Stair climbing thus leads to more challenging patellofemoral contact mechanics and kinematics than level walking at early knee flexion. The increase in patellofemoral pressure, lateral force distribution and lateral tilt during stair climbing provides a possible biomechanical explanation for the patellofemoral pain frequently experienced during this activity.     

Wide step width reduces knee abduction moment of obese adults during stair negotiation

PurposeAn increased likelihood of developing obesity-related knee osteoarthritis may be associated with increased peak internal knee abduction moments (KAbM). Increases in step width (SW) may act to reduce this moment. The purpose of this study was to determine the effects of increased SW on knee biomechanics during stair negotiation of healthy-weight and obese participants.MethodsParticipants (24: 10 obese and 14 healthy-weight) used stairs and walked over level ground while walking at their preferred speed in two different SW conditions – preferred and wide (200% preferred). A 2 × 2 (group × condition) mixed model analysis of variance was performed to analyze differences between groups and conditions (p < 0.05).ResultsIncreased SW increased the loading-response peak knee extension moment during descent and level gait, decreased loading-response KAbMs, knee extension and abduction range of motion (ROM) during ascent, and knee adduction ROM during descent. Increased SW increased loading-response peak mediolateral ground reaction force (GRF), increased peak knee abduction angle during ascent, and decreased peak knee adduction angle during descent and level gait. Obese participants experienced disproportionate changes in loading-response mediolateral GRF, KAbM and peak adduction angle during level walking, and peak knee abduction angle and ROM during ascent.ConclusionIncreased SW successfully decreased loading-response peak KAbM. Implications of this finding are that increased SW may decrease medial compartment knee joint loading, decreasing pain and reducing joint deterioration. Increased SW influenced obese and healthy-weight participants differently and should be investigated further.     

The Energy Expenditure of Stair Climbing One Step and Two Steps at a Time: Estimations from Measures of Heart Rate

Stairway climbing provides a ubiquitous and inconspicuous method of burning calories. While typically two strategies are employed for climbing stairs, climbing one stair step per stride or two steps per stride, research to date has not clarified if there are any differences in energy expenditure between them. Fourteen participants took part in two stair climbing trials whereby measures of heart rate were used to estimate energy expenditure during stairway ascent at speeds chosen by the participants. The relationship between rate of oxygen consumption () and heart rate was calibrated for each participant using an inclined treadmill. The trials involved climbing up and down a 14.05 m high stairway, either ascending one step per stride or ascending two stair steps per stride. Single-step climbing used 8.5±0.1 kcal min⁻¹, whereas double step climbing used 9.2±0.1 kcal min⁻¹. These estimations are similar to equivalent measures in all previous studies, which have all directly measured The present study findings indicate that (1) treadmill-calibrated heart rate recordings can be used as a valid alternative to respirometry to ascertain rate of energy expenditure during stair climbing; (2) two step climbing invokes a higher rate of energy expenditure; however, one step climbing is energetically more expensive in total over the entirety of a stairway. Therefore to expend the maximum number of calories when climbing a set of stairs the single-step strategy is better.     

Introducing a new staircase design to quantify healthy knee function during stair ascent and descent

The design, manufacture and validation of a new free standing staircase for motion analysis measurements are described in this paper. The errors in vertical force measurements introduced when the stairs interface with a force plate (FP) are less than 0.6%. The centre of pressure error introduced is less than 0.7 mm compared to the error from the FP. The challenges of introducing stair gait into a clinical trial with a limited number of FPs and time limitations for assessment sessions are addressed by introducing this cost effective solution.

The staircase was used in a study to measure non-pathological knee function of 10 subjects performing stair ascent and descent. The resulting knee kinematics and knee joint moments are in agreement with previous studies. The kinematic and joint moment profiles provide a normative range, which will be useful in future studies for identifying alterations in joint function associated with pathology and intervention.     

The effects of weight loss on relative bone mineral density in premenopausal women

Objective:

This study compared BMD relative to body weight following a ～6‐month weight loss program and a 1‐year weight maintenance phase in premenopausal women and determined whether African American (AA) and European‐American (EA) women's BMD respond similarly during weight loss.

Design and Methods:

Premenopausal women (n = 115, 34 ± 5 years) were evaluated in an overweight state (BMI between 27 and 30 kg/m²), following an 800 kcal/day diet/exercise program designed to reduce BMI<25 kg/m², and 1‐year following weight loss.

Results:

BMD relative to body weight (Z‐scores) increased after weight loss, but decreased during the 1‐year weight maintenance phase. All 1‐year follow‐up BMD Z‐scores were increased (except L1) compared to baseline measurements (P < 0.05). These sites included the hip neck (+0.088, P = 0.014), total hip (+0.099, P = 0.001), L2 (+0.127, P = 0.013), L3 (+0.135, P = 0.014), and L4 (+0.199, P = 0.002). AAs had significantly higher absolute BMD at all sites (P < 0.05) compared to EAs, but no time by race interactions were evident during weight loss (except in L3).

Conclusion:

These results may indicate that weight loss is safe with regard to bone health for overweight premenopausal women.     

Gastrocnemius muscle fascicle behavior during stair negotiation in humans.

The aim of the present study was to establish the behavior of human medial gastrocnemius (GM) muscle fascicles during stair negotiation. Ten healthy male subjects performed normal stair ascent and descent at their own comfortable speed on a standard-dimension four-step staircase with embedded force platforms in each step. Kinematic, kinetic, and electromyographic data of the lower limbs were collected. Real-time ultrasound scanning was used to determine GM muscle fascicle length changes. Musculotendon complex (MTC) length changes were estimated from ankle and knee joint kinematics. The GM muscle was mainly active during the push-off phase in stair ascent, and the muscle fascicles contracted nearly isometrically. The GM muscle was mainly active during the touch-down phase of stair descent where the MTC was lengthened; however, the GM muscle fascicles shortened by approximately 7 mm. These findings show that the behavior and function of GM muscle fascicles in stair negotiation is different from that expected on the basis of length changes of the MTC as derived from joint kinematics.     

Triaxial accelerometry for assessment of physical activity in young children

Objective: The purpose of the present study was to derive linear and non‐linear regression equations that estimate energy expenditure (EE) from triaxial accelerometer counts that can be used to quantitate activity in young children. We are unaware of any data regarding the validity of triaxial accelerometry for assessment of physical activity intensity in this age group. Research Methods and Procedures: EE for 27 girls and boys (6.0 ± 0.3 years) was assessed for nine activities (lying down, watching a video while sitting and standing, line drawing for coloring‐in, playing blocks, walking, stair climbing, ball toss, and running) using indirect calorimetry and was then estimated using a triaxial accelerometer (ActivTracer, GMS). Results: Significant correlations were observed between synthetic (synthesized tri‐axes as the vector), vertical, and horizontal accelerometer counts and EE for all activities (0.878 to 0.932 for EE). However, linear and non‐linear regression equations underestimated EE by >30% for stair climbing (up and down) and performing a ball toss. Therefore, linear and non‐linear regression equations were calculated for all activities except these two activities, and then evaluated for all activities. Linear and non‐linear regression equations using combined vertical and horizontal acceleration counts, synthetic counts, and horizontal counts demonstrated a better relationship between accelerometer counts and EE than did regression equations using vertical acceleration counts. Adjustment of the predicted value by the regression equations using the vertical/horizontal counts ratio improved the overestimation of EE for performing a ball toss. Discussion: The results suggest that triaxial accelerometry is a good tool for assessing daily EE in young children.     

A family-based approach to preventing excessive weight gain

Objective: Preventing weight gain in adults and excessive weight gain in children is a high priority. We evaluated the ability of a family‐based program aimed at increasing steps and cereal consumption (for breakfast and snacks) to reduce weight gain in children and adults. Research Methods and Procedures: Families (n = 105) with at least one 8‐ to 12‐year‐old child who was at‐risk‐for‐overweight or overweight (designated as the target child) were recruited for the study. Eighty‐two families were randomly assigned to receive the family‐based intervention and 23 families to the control condition. The 13‐week intervention consisted of specific increases in daily steps (an additional 2000 steps/d) and consumption of 2 servings/d of ready‐to‐eat cereal. Results: The intervention was successful in increasing walking (steps) and cereal consumption. The intervention had positive, significant effects on percentage BMI‐for‐age and percentage body fat for target children and weight, BMI, and percentage body fat for parents. On further analysis, the positive effects of the intervention were seen largely in target girls and moms, rather than in target boys and dads. Discussion: This family‐based weight gain prevention program based on small changes holds promise for reducing excessive weight gain in families and especially in growing overweight children.     

Labor Saved,Calories Lost: The Energetic Impact of Domestic Labor‐saving Devices

Objective: As the prevalence of obesity has increased, so has sedentariness. Progressive sedentariness has been attributed to greater use of labor saving devices, such as washing machines, and less nonexercise walking (e.g., walking to work). However, there is a paucity of data to support this conclusion. In this study, we address the hypothesis that domestic mechanization of daily tasks has resulted in less energy expenditure compared with performing the same tasks manually. Research Methods and Procedures: Energy expenditure was measured in four groups of subjects (122 healthy adult men and women total) from Rochester, Minnesota. Energy expenditure was measured using indirect calorimetry while subjects performed structured tasks such as cleaning dishes and clothes, stair climbing, and work‐associated transportation, and these values were compared with the respective mechanized activity. Results: Energy expenditure was significantly greater and numerically substantial when daily domestic tasks were performed without the aid of machines or equipment (clothes washing: 45 ± 14 vs. 27 ± 9 kcal/d; dish washing: 80 ± 28 vs. 54 ± 19 kcal/d; transportation to work: 83 ± 17 vs. 25 ± 3 kcal/d; stair climbing: 11 ± 7 vs. 3 ± 1 kcal/d; p < 0.05). The combined impact of domestic mechanization was substantial and equaled 111 kcal/d. Discussion: The magnitude of the energetic impact of the mechanized tasks we studied was sufficiently great to contribute to the positive energy balance associated with weight gain. Efforts focused on reversing sedentariness have the potential to impact obesity.     

Randomized Control Trial to Improve Adiposity and Insulin Resistance in Overweight Latino Adolescents

Few randomized trials attempt to improve insulin sensitivity and associated metabolic risks in overweight Latino youth. The purpose of this study is to examine the effects of a modified carbohydrate nutrition program combined with strength training on insulin sensitivity, adiposity, and other type 2 diabetes risk factors in overweight Latino adolescents. In a 16‐week randomized trial, 54 overweight Latino adolescents (15.5 ± 1.0 years) were randomly assigned to: (i) Control (C; n = 16), (ii) Nutrition (N; n = 21), or (iii) Nutrition + Strength training (N+ST; n = 17). The N group received modified carbohydrate nutrition classes (once per week), while the N+ST received the same nutrition classes plus strength training (twice per week). The following were measured at pre‐ and postintervention: strength by 1‐repetition maximum, dietary intake by 3‐day records, body composition by dual‐energy X‐ray absorptiometry, glucose/insulin indices by oral glucose tolerance test (OGTT) and intravenous glucose tolerance test with minimal modeling. Across intervention group effects were tested using analysis of covariance with post hoc pairwise comparisons. A significant overall intervention effect was found for improvement in bench press (P < 0.001) and reductions in energy (P = 0.05), carbohydrate (P = 0.04) and fat intake (P = 0.03). There were no significant intervention effects on insulin sensitivity, body composition, or most glucose/insulin indices with the exception of glucose incremental area under the curve (IAUC) (P = 0.05), which decreased in the N and N+ST group by 18 and 6.3% compared to a 32% increase in the C group. In conclusion, this intense, culturally tailored intervention resulted in no significant intervention effects on measured risk factors with the exception of a beneficial effect on glycemic response to oral glucose.     

Regular Aerobic Exercise,Without Weight Loss,Improves Endothelium‐dependent Vasodilation in Overweight and Obese Adults

Lifestyle modification in the form of weight reduction by caloric restriction alone or in combination with regular aerobic exercise significantly improves endothelium‐dependent vasodilation in overweight and obese adults. We determined whether regular aerobic exercise, independent of weight loss, improves endothelium‐dependent vasodilation in overweight and obese adults. Twenty overweight and obese adults (age 53 ± 1 years; BMI: 30.2 ± 0.8 kg/m²) were studied before and after a 3‐month aerobic exercise training intervention. Forearm blood flow (FBF) responses were determined (via plethysmography) in response to intra‐arterial infusion of acetylcholine and sodium nitroprusside. There were no changes in body mass or composition with the intervention. FBF responses to acetylcholine were ～35% higher (P < 0.01) after (4.1 ± 0.9 to 14.7 ± 4.3 ml/100 ml tissue/min) compared with before (4.2 ± 0.8 to 11.0 ± 3 ml/100 ml tissue/min) exercise training. FBF responses to sodium nitroprusside were unchanged. These results indicate that regular aerobic exercise improves endothelium‐dependent vasodilation in overweight and obese adults, independent of changes in body mass or composition.     

Immigrational Background Affects the Effectiveness of a School‐based Overweight Prevention Program Promoting Water Consumption

We tested whether a simple overweight prevention program promoting water consumption in elementary schools is equally effective in children with an immigrational background (MIG) and in those without (non‐MIG). Thus, a secondary analysis of a controlled cluster trial, lasting one school year, was conducted. Thirty‐two elementary schools located in low socioeconomic districts in two German cities were included. Of the 2,950 school children analyzed, 1,306 were MIG children. Water fountains were installed in the schools of the intervention group (IG) and teachers held lessons to promote water consumption. Control schools (control group (CG)) did not receive any intervention. Before and after intervention, body weight and height was measured. Overweight was defined by age‐ and sex‐specific BMI cutoffs that are linked to an adult BMI of 25 kg/m². Beverage consumption was assessed in questionnaires. Modification of intervention effects by immigrational background was tested by interaction terms. The immigrational background modified the intervention effect on prevalence and remission of overweight (interaction term: P = 0.03 and P = 0.02), but not on the incidence of overweight (P = 0.06). After intervention, the risk of being overweight was reduced in the IG compared to the CG among non‐MIG (odds ratio = 0.51, 95% confidence interval (CI): 0.31–0.83), but not among MIG children (odds ratio = 1.02, 95% CI: 0.63–1.65). After intervention, water consumption significantly increased in the IG equally among both, non‐MIG and MIG, by ～1 glass/day. A simple school‐based intervention promoting water consumption prevented overweight in non‐MIG children, but failed in MIG children. Different beverage consumption, among other lifestyle factors, may account for this effect but scientific discussion remains open.     

Twenty-four-hour ghrelin is elevated after calorie restriction and exercise training in non-obese women

Objective: The purpose of this study was to determine whether chronic energy deficiency achieved with caloric restriction combined with exercise is associated with changes in the 24‐hour profile of ghrelin in non‐obese, pre‐menopausal women. Research Methods and Procedures: Twelve non‐obese (BMI = 18 to 25 kg/m²), non‐exercising women (age, 18 to 24 years) were randomly assigned to a non‐exercising control group or a diet and exercise group. The 3‐month diet and exercise intervention yielded a daily energy deficit of ?45.7 ± 12.4%. Serial measurements were made of body composition, energy balance, and feelings of fullness. Repeated blood sampling over 24 hours to measure ghrelin occurred before and after the study. Results: Significant decreases in body weight, body fat, and feelings of fullness were observed in only the energy‐deficit group (p < 0.05); significant changes in the following ghrelin features were found in only the deficit group (p < 0.05): elevations in baseline (+353 ± 118 pg/mL), lunch peak (+370 ± 102 pg/mL), dinner peak (+438 ± 149 pg/mL), nocturnal rise (+269 ± 77 pg/mL), and nocturnal peak (+510 ± 143 pg/mL). In addition, we found a larger dinner decline (?197 ± 52 pg/mL) and negative correlations between changes in the ghrelin dinner profile and changes in body weight (R = 0.784), 24‐hour intake (R = 0.67), energy deficiency (R = 0.762), and feelings of fullness (R = 0.648; p < 0.05). Discussion: Changes in ghrelin concentrations across the day after weight loss are closely associated with other physiological adaptations to energy deficiency, further supporting the role of ghrelin as a countermeasure to restore energy balance.     

Whole-body angular momentum during stair walking using passive and powered lower-limb prostheses*

Individuals with a unilateral transtibial amputation have a greater risk of falling compared to able-bodied individuals, and falling on stairs can lead to serious injuries. Individuals with transtibial amputations have lost ankle plantarflexor muscle function, which is critical for regulating whole-body angular momentum to maintain dynamic balance. Recently, powered prostheses have been designed to provide active ankle power generation with the goal of restoring biological ankle function. However, the effects of using a powered prosthesis on the regulation of whole-body angular momentum are unknown. The purpose of this study was to use angular momentum to evaluate dynamic balance in individuals with a transtibial amputation using powered and passive prostheses relative to able-bodied individuals during stair ascent and descent. Ground reaction forces, external moment arms, and joint powers were also investigated to interpret the angular momentum results. A key result was that individuals with an amputation had a larger range of sagittal-plane angular momentum during prosthetic limb stance compared to able-bodied individuals during stair ascent. There were no significant differences in the frontal, transverse, or sagittal-plane ranges of angular momentum or maximum magnitude of the angular momentum vector between the passive and powered prostheses during stair ascent or descent. These results indicate that individuals with an amputation have altered angular momentum trajectories during stair walking compared to able-bodied individuals, which may contribute to an increased fall risk. The results also suggest that a powered prosthesis provides no distinct advantage over a passive prosthesis in maintaining dynamic balance during stair walking.     

Quality of life in Mexican-American children following a weight management program

Objective: The objective was to evaluate quality of life (QOL) in at‐risk‐for‐overweight and overweight Mexican‐American children after participating in 6 months of intensive weight management or self‐help. Research Methods and Procedures: Eighty sixth‐ and seventh‐grade at‐risk‐for‐overweight (BMI ≥85th to <95th percentile) and overweight (BMI ≥95th percentile) Mexican‐American children were randomly assigned to either intensive instructor‐led intervention (ILI) or self‐help (SH). The ILI condition included daily participation for 12 weeks in a school‐based program comprised of nutrition education, physical activity, and behavior modification, followed by ongoing monthly maintenance. QOL was assessed at baseline and 6 months via child self‐report PedsQL. QOL outcomes were compared across treatment groups, and the impact of change in zBMI on change in QOL was evaluated. Results: Children in the ILI condition not only achieved significantly greater weight loss (zBMI, ?0.13 ± 0.14; p < 0.001) but also significantly greater physical QOL improvements than those in the SH condition at 6 months (p < 0.05). Furthermore, physical QOL increases were associated with zBMI reduction (p < 0.05). However, neither psychosocial nor total QOL was significantly impacted by intervention or zBMI change. Discussion: These findings show that even modest decreases in zBMI after weight management result in improved physical QOL in Mexican‐American children. These results illustrate the clear need to include evaluation of QOL in the process of identifying effective weight management programs.     

Balance control during stair negotiation in older adults

Stair negotiation is among the most challenging and hazardous types of locomotion for older people. However, the effect of aging on balance control during stair negotiation has not been investigated. Instantaneous inclination angles between the center of mass (CoM) and center of pressure (CoP) have been reported to detect gait instability effectively in the elderly. The purpose of this study was to compare the CoM-CoP inclination angles between 12 healthy elderly and 13 healthy young adults when performing stair ascent (SA) and descent (SD) on a three-step staircase. Whole body motion data were collected with an eight-camera motion analysis system. Four force plates were mounted on the floor as well as the first two steps to measure ground reaction forces. No significant group differences were detected in any of the temporal-distance gait measures and CoM-CoP inclination angles during SA and SD. Compared to the floor-to-stair transition phase, both groups demonstrated a significantly greater CoM-CoP medial inclination angle while ascending the stairs. However, a significant reduction in medial inclination was only detected in young adults when transferring from SD to level ground walking. Elderly adults were found to demonstrate a significantly greater medial inclination angle during the stair-to-floor transition phase when compared to young adults. Age-related degenerations in the elderly could compromise their ability to regulate body sway during the stair-to-floor transition, which may subsequently increase the risk of falling.     

Four-year follow-up of school-based intervention on overweight children: the KOPS study

Objective: To evaluate the 4‐year outcome of a school‐based health promotion on weight status as part of the Kiel Obesity Prevention Study (KOPS). Research Methods and Procedures: Within a cluster‐sampled quasi‐randomized controlled trial, 1764 children at 6 and 10 years of age were assessed between 1996 and 2005 in 32 primary schools in Kiel, North Germany. Six nutrition units followed by 20‐minute running games were performed within the first year at school. Prevalence, incidence, and remission of overweight were main outcome measures. Results: The 4‐year change in BMI was +11.6%, with increases in prevalence of overweight and obesity from 5.2% to 11.1% and 3.9% to 5.1%, respectively. Cumulative 4‐year incidence of overweight and obesity was 9.2% and 3.1%, respectively. Intervention had no effect on mean BMI. The effect on prevalence was significant in children from families with high socioeconomic status [odds ratio (OR), 0.35; 95% confidence interval (CI), 0.14 to 0.91] and marginally significant in children of normal‐weight mothers (OR, 0.57; 95% CI, 0.33 to 1.00). Cumulative 4‐year incidence of overweight was lower only in intervention children from families with high socioeconomic status (OR, 0.26; 95% CI, 0.07 to 0.87). Remission of overweight was most pronounced in children of normal‐weight mothers (OR, 5.43; 95% CI, 1.28 to 23.01). Prevalence of underweight was unchanged. The intervention had minor but favorable effects on lifestyle. Discussion: A school‐based health promotion has sustainable effects on remission and incidence of overweight; it was most pronounced in children of normal‐weight mothers and children from families with high socioeconomic status. There was no effect on obesity. The data argue in favor of additional measures of prevention.     

Evaluation of a multisensor armband in estimating energy expenditure in obese individuals

Objective: To examine the reliability and validity of the SenseWear Pro 2 Armband (SWA; Body Media, Pittsburgh, PA) during rest and exercise compared with indirect calorimetry (IC) in obese individuals. Research Methods and Procedures: Energy expenditure was assessed during rest with the SWA and IC in 142 obese adults (37 men and 105 women, BMI = 42.3 ± 7.0) and in 25 lean and overweight adults (BMI = 25.3 ± 3.2) who were used as a comparison group. Twenty‐nine of the obese adults also participated in three separate short exercise sessions including cycle ergometry, stair stepping, and treadmill walking. Results: The repeatability of SWA estimates in obese subjects was high (r = 0.88, p < 0.001). The SWA generally underestimated the resting energy expenditure (REE) (1811 ± 346 vs. 1880 ± 382 kcal/d) and highly overestimated the energy expenditure during the exercise sessions in obese individuals. REE estimations by SWA were significantly correlated with fat‐free mass (r = 0.88, p < 0.001). Bland‐Altman plots based statistical analysis for the estimated REE, and measured IC showed a low agreement (Total Error > 20% but Systematic Error < 5%) between the two methods in obese subjects, although they showed a high correlation and a very good agreement in lean and overweight patients. Discussion: The SWA is an easy to handle, practical, new portable device for measuring energy expenditure. The accuracy of the SWA appeared to be poor in the obese subjects we examined, especially those with high REE both in rest and exercise. We believe that it is necessary to incorporate new, obesity‐specific algorithms in the relative software.     

Intensive weight loss program improves physical function in older obese adults with knee osteoarthritis

Objective: Physical function and body composition in older obese adults with knee osteoarthritis (OA) were examined after intensive weight loss. Research Methods and Procedures: Older obese adults (n = 87; ≥60 years; BMI ≥ 30.0 kg/m²) with symptomatic knee OA and difficulty with daily activities were recruited for a 6‐month trial. Participants were randomized into either a weight stable (WS) or weight loss (WL) program. Participants in WL (10% weight loss goal) were prescribed a 1000 kcal/d energy deficit diet with exercise 3 d/wk. WS participants attended health information sessions. Body composition and physical function (Western Ontario and McMaster University Osteoarthritis Index, 6‐minute walking distance, and stair climb time) were assessed at baseline and 6 months. Statistical analysis included univariate analysis of covariance on 6‐month measurements using baseline values as covariates. Associations between physical function and body composition were performed. Results: Body weight decreased 8.7 ± 0.8% in WL and 0.0 ± 0.7% in WS. Body fat and fat‐free mass were lower for WL than WS at 6 months (estimated means: fat = 38.1 ± 0.4% vs. 40.9 ± 0.4%, respectively; fat‐free mass = 56.7 ± 0.4 vs. 58.8 ± 0.4 kg, respectively). WL had better function than WS, with lower Western Ontario and McMaster University Osteoarthritis Index scores, greater 6‐minute walk distance, and faster stair climb time (p < 0.05). Changes in function were associated with weight loss in the entire cohort. Discussion: An intensive weight loss intervention incorporating energy deficit diet and exercise training improves physical function in older obese adults with knee OA. Greater improvements in function were observed in those with the most weight loss.     

Aerobic exercise and snoring in overweight children: a randomized controlled trial

Objective: To determine whether regular aerobic exercise improves symptoms of sleep‐disordered breathing in overweight children, as has been shown in adults. Research Methods and Procedures: Healthy but overweight (BMI ≥85th percentile) 7‐ to 11‐year‐old children were recruited from public schools for a randomized controlled trial of exercise effects on diabetes risk. One hundred children (53% black, 41% male) were randomly assigned to a control group (n = 27), a low‐dose exercise group (n = 36), or a high‐dose exercise group (n = 37). Exercise groups underwent a 13 ± 1.5 week after‐school program that provided 20 or 40 minutes per day of aerobic exercise (average heart rate = 164 beats per minute). Group changes were compared on BMI z‐score and four Pediatric Sleep Questionnaire scales: Snoring, Sleepiness, Behavior, and a summary scale, Sleep‐Related Breathing Disorders. Analyses were adjusted for age. Results: Both the high‐dose and low‐dose exercise groups improved more than the control group on the Snoring scale. The high‐dose exercise group improved more than the low‐dose exercise and control groups on the summary scale. No group differences were found for changes on Sleepiness, Behavior, or BMI z‐score. At baseline, 25% screened positive for sleep‐disordered breathing; half improved to a negative screen after intervention. Discussion: Regular vigorous exercise can improve snoring, a symptom of sleep‐disordered breathing, in overweight children. Aerobic exercise programs may be valuable for prevention and treatment of sleep‐disordered breathing in overweight children.