Department of Orthopaedics and Rehabilitation, Interdisciplinary Center for Musculoskeletal Training and Research, University of Florida, Gainesville 32611, USA.
Am J Phys Med Rehabil. 2013 May;92(5):430-8. doi: 10.1097/PHM.0b013e31828763a0.
This study determined whether mobility and functional pain were different among older men and women with chronic low-back pain and varying body mass index levels.
This was a comparative, descriptive study of older adults with obesity with low-back pain (N = 55; 60-85 yrs). The participants were stratified on the basis of body mass index: overweight (25-29.9 kg/m), obese (30-34.9 kg/m), and severely obese (35 kg/m). The participants completed a functional test battery (walking endurance, chair rise, stair climb, 7-day activity monitoring, and gait parameters) and pain ratings with activity ("functional pain").
The functional pain scores during walking and stair climb were highest in the severely obese group compared with the overweight group (P < 0.05), but the functional test scores were not found to be significantly different by body mass index. Gait base of support was 36% greater and single/double support times were 3.1%-6.1% greater in the severely obese group compared with the overweight group (P < 0.05). The women had slower chair rise and stair climb times and had slower walking velocity than did the men. Daily step numbers were lowest in the severely obese group compared with the obese and overweight groups (2971 vs. 3511 and 4421 steps per day; P < 0.05) but were not different by sex. Normalized lumbar extensor, abdominal curl, and leg press strength values were lowest in the severely obese group, and the women had 18%-34% lower strength values than did the men for all three exercises (P < 0.05). Lumbar strength was associated with stair climb, chair rise, and walking endurance times. Body mass index was an independent predictor of walking endurance time but not of steps taken per day.
In this study, the persons with obesity reported higher functional pain values during walking and stair climb and had lower lumbar strength compared with the overweight participants. Rehabilitation strategies that include lumbar extensor strengthening may help improve functional mobility and walking duration, both of which can help with weight management in older adults with obesity with chronic low-back pain.
本研究旨在确定慢性下腰痛且身体质量指数（BMI）水平不同的老年男性和女性在活动能力和功能性疼痛方面是否存在差异。
这是一项针对肥胖合并下腰痛的老年人（N=55；60-85 岁）的比较性、描述性研究。参与者根据 BMI 进行分层：超重（25-29.9kg/m）、肥胖（30-34.9kg/m）和严重肥胖（35kg/m）。参与者完成了功能测试组合（步行耐力、椅子站立、楼梯攀爬、7 天活动监测和步态参数）和活动时的疼痛评分（“功能性疼痛”）。
与超重组相比，严重肥胖组在步行和楼梯攀爬时的功能性疼痛评分最高（P<0.05），但功能测试评分并未因 BMI 而显著不同。与超重组相比，严重肥胖组的步态支撑基础增加了 36%，单/双支撑时间增加了 3.1%-6.1%（P<0.05）。女性的椅子站立和楼梯攀爬时间较慢，步行速度也比男性慢。与肥胖组和超重组相比，严重肥胖组每天的步数最低（2971 步 vs. 3511 步和 4421 步；P<0.05），但性别间无差异。严重肥胖组的腰椎伸肌、腹肌卷曲和腿部按压力量的标准化值最低，女性在所有三项运动中的力量值比男性低 18%-34%（P<0.05）。腰椎力量与楼梯攀爬、椅子站立和步行耐力时间相关。BMI 是步行耐力时间的独立预测因子，但不是每天步数的独立预测因子。
在这项研究中，肥胖者在步行和楼梯攀爬时报告的功能性疼痛值较高，且与超重参与者相比，腰椎力量较低。包括腰椎伸肌强化在内的康复策略可能有助于提高功能性活动能力和步行持续时间，这两者都有助于肥胖合并慢性下腰痛的老年人进行体重管理。
