The Relationship Between Joint Loading and Physical Activity Level in Middle-Aged Adults with Obesity, and the Role of Body Composition

Background Osteoarthritis is a leading cause of disability and is accompanied by pain, high medical expenditures, and poor quality of life. Adults with obesity develop osteoarthritis at twice the rate of normal weight adults, in part due to higher joint loading. Middle-aged adults have the highest prevalence of obesity among adult age groups. Physical activity is recommended for overall health benefits and can improve walking mechanics. Changes in bodyweight composition and distribution also influence biomechanical control of gait. Purpose This analysis evaluated how daily physical activity level (PAL) is related to joint loading during gait in middle-aged adults with obesity, and the role of body composition on these relationships. Methods Twenty-nine middle-aged (52.1 ± 8.1 years) adults with obesity (36.1 ± 3.6 kg/m 2 ) walked over an instrumented walkway. Maximum vertical ground reaction force (max vGRF), total stance load (TL), and loading rate (LR) were calculated. Participants completed one week of at-home wrist-worn activity monitoring. Results PAL was associated with max vGRF (ρ = -0.64, P < 0.001) and TL (ρ = -0.57, P = 0.001). Waist to hip ratio (WHR) and bodyfat percentage (BFP) independently mediated the relationships between PAL and joint loading variables explaining up to 36% and 31% of the variance in joint loading in multiple regression models, respectively. Conclusions Middle-aged adults with higher PAL demonstrated smaller joint loading during gait. Relationships between joint loading and PAL were mediated by WHR and BFP. Promoting physical activity and tracking changes to body composition are important for reducing joint loading during walking even when weight loss is not considered.