DeVita Paul, Hortobágyi Tibor
Biomechanics Laboratory, Department of Exercise and Sport Science, East Carolina University, 27858, Greenville, NC, USA.
J Biomech. 2003 Sep;36(9):1355-62. doi: 10.1016/s0021-9290(03)00119-2.
While it is widely speculated that obesity causes increased loads on the knee leading to joint degeneration, this concept is untested. The purpose of the study was to identify the effects of obesity on lower extremity joint kinetics and energetics during walking. Twenty-one obese adults were tested at self-selected (1.29m/s) and standard speeds (1.50m/s) and 18 lean adults were tested at the standard speed. Motion analysis and force platform data were combined to calculate joint torques and powers during the stance phase of walking. Obese participants were more erect with 12% less knee flexion and 11% more ankle plantarflexion in self-selected compared to standard speeds (both p<0.02). Obese participants were still more erect than lean adults with approximately 6 degrees more extension at all joints (p<0.05, for each joint) at the standard speed. Knee and ankle torques were 17% and 11% higher (p<0.034 and p<0.041) and negative knee work and positive ankle work were 68% and 11% higher (p<0.000 and p<0.048) in obese participants at the standard speed compared to the slower speed. Joint torques and powers were statistically identical at the hip and knee but were 88% and 61% higher (both p<0.000) at the ankle in obese compared to lean participants at the standard speed. Obese participants used altered gait biomechanics and despite their greater weight, they had less knee torque and power at their self-selected walking speed and equal knee torque and power while walking at the same speed as lean individuals. We propose that the ability to reorganize neuromuscular function during gait may enable some obese individuals to maintain skeletal health of the knee joint and this ability may also be a more accurate risk indicator for knee osteoarthritis than body weight.
虽然人们普遍推测肥胖会导致膝关节负荷增加,进而引发关节退变,但这一概念尚未得到验证。本研究的目的是确定肥胖对步行过程中下肢关节动力学和能量学的影响。对21名肥胖成年人进行了自选速度(1.29米/秒)和标准速度(1.50米/秒)测试,对18名瘦成年人进行了标准速度测试。结合运动分析和力平台数据,计算步行站立期的关节扭矩和功率。与标准速度相比,肥胖参与者在自选速度下站立时身体更挺直,膝关节屈曲减少12%,踝关节跖屈增加11%(均p<0.02)。在标准速度下,肥胖参与者仍比瘦成年人更挺直,所有关节的伸展角度大约多6度(每个关节p<0.05)。与较慢速度相比,肥胖参与者在标准速度下膝关节和踝关节扭矩分别高17%和11%(p<0.034和p<0.041),膝关节负功和踝关节正功分别高68%和11%(p<0.000和p<0.048)。在标准速度下,肥胖参与者与瘦参与者相比,髋关节和膝关节的扭矩和功率在统计学上相同,但踝关节的扭矩和功率分别高88%和61%(均p<0.000)。肥胖参与者步态生物力学发生改变,尽管体重较大,但在自选步行速度下膝关节扭矩和功率较小,而与瘦人以相同速度行走时膝关节扭矩和功率相当。我们认为,在步态中重新组织神经肌肉功能的能力可能使一些肥胖个体维持膝关节的骨骼健康,并且这种能力可能比体重更准确地指示膝关节骨关节炎的风险。