A Pilot Study of Iyengar Yoga for Pediatric Obesity: Effects on Gait and Emotional Functioning

Keri R Hainsworth, Xue Cheng Liu, Pippa M Simpson, Ann M Swartz, Nina Linneman, Susan T Tran, Gustavo R Medrano, Bryant Mascarenhas, Liyun Zhang, Steven J Weisman, Keri R Hainsworth, Xue Cheng Liu, Pippa M Simpson, Ann M Swartz, Nina Linneman, Susan T Tran, Gustavo R Medrano, Bryant Mascarenhas, Liyun Zhang, Steven J Weisman

Abstract

Obesity negatively impacts the kinematics and kinetics of the lower extremities in children and adolescents. Although yoga has the potential to provide several distinct benefits for children with obesity, this is the first study to examine the benefits of yoga for gait (primary outcome) in youths with obesity. Secondary outcomes included health-related quality of life (HRQoL), physical activity, and pain. Feasibility and acceptability were also assessed. Nine youths (11⁻17 years) participated in an eight-week Iyengar yoga intervention (bi-weekly 1-h classes). Gait, HRQOL (self and parent-proxy reports), and physical activity were assessed at baseline and post-yoga. Pain was self-reported at the beginning of each class. Significant improvements were found in multiple gait parameters, including hip, knee, and ankle motion and moments. Self-reported and parent-proxy reports of emotional functioning significantly improved. Time spent in physical activity and weight did not change. This study demonstrates that a relatively brief, non-invasive Iyengar yoga intervention can result in improved malalignment of the lower extremities during ambulation, as well as in clinically meaningful improvements in emotional functioning. This study extends current evidence that supports a role for yoga in pediatric obesity.

Keywords: biomechanics; health-related quality of life; obesity; pediatrics; yoga.

Conflict of interest statement

The authors declare no conflicts of interest. The founding sponsors had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript, and in the decision to publish the results.

References

    1. Ogden C.L., Carroll M.D., Kit B.K., Flegal K.M. Prevalence of childhood and adult obesity in the United States, 2011–2012. JAMA. 2014;311:806–814. doi: 10.1001/jama.2014.732.
    1. Afshin A., Forouzanfar M.H., Reitsma M.B., Sur P., Estep K., Lee A., Marczak L., Mokdad A.H., Moradi-Lakeh M., Naghavi M. Health effects of overweight and obesity in 195 countries over 25 years. N. Engl. J. Med. 2017;377:13–27.
    1. Gordon-Larsen P., The N.S., Adair L.S. Longitudinal trends in obesity in the United States from adolescence to the third decade of life. Obesity. 2010;18:1801–1804. doi: 10.1038/oby.2009.451.
    1. Kelly A.S., Barlow S.E., Rao G., Inge T.H., Hayman L.L., Steinberger J., Urbina E.M., Ewing L.J., Daniels S.R., American Heart Association Atherosclerosis, Hypertension, and Obesity in the Young Committee of the Council on Cardiovascular Disease in the Young, Council on Nutrition, Physical Activity and Metabolism, and Council on Clinical Cardiology Severe obesity in children and adolescents: Identification, associated health risks, and treatment approaches: A scientific statement from the American Heart Association. Circulation. 2013;128:1689–1712. doi: 10.1161/CIR.0b013e3182a5cfb3.
    1. Skinner A.C., Ravanbakht S.N., Skelton J.A., Perrin E.M., Armstrong S.C. Prevalence of Obesity and Severe Obesity in US Children, 1999–2016. Pediatrics. 2018;141:e20173459. doi: 10.1542/peds.2017-3459.
    1. Daniels S.R. Complications of obesity in children and adolescents. Int. J. Obes. 2009;33(Suppl. 1):S60–S65. doi: 10.1038/ijo.2009.20.
    1. Schwimmer J.B., Burwinkle T.M., Varni J.W. Health-related quality of life of severely obese children and adolescents. JAMA. 2003;289:1813–1819. doi: 10.1001/jama.289.14.1813.
    1. Williams J., Wake M., Hesketh K., Maher E., Waters E. Health-related quality of life of overweight and obese children. JAMA. 2005;293:70–76. doi: 10.1001/jama.293.1.70.
    1. Widhalm H.K., Seemann R., Hamboeck M., Mittlboeck M., Neuhold A., Friedrich K., Hajdu S., Widhalm K. Osteoarthritis in morbidly obese children and adolescents, an age-matched controlled study. Knee Surg. Sports Traumatol. Arthrosc. 2016;24:644–652. doi: 10.1007/s00167-014-3068-4.
    1. Widhalm H.K., Marlovits S., Welsch G.H., Dirisamer A., Neuhold A., van Griensven M., Seemann R., Vecsei V., Widhalm K. Obesity-related juvenile form of cartilage lesions: A new affliction in the knees of morbidly obese children and adolescents. Eur. Radiol. 2012;22:672–681. doi: 10.1007/s00330-011-2281-5.
    1. Deere K.C., Clinch J., Holliday K., McBeth J., Crawley E.M., Sayers A., Palmer S., Doerner R., Clark E.M., Tobias J.H. Obesity is a risk factor for musculoskeletal pain in adolescents: Findings from a population-based cohort. Pain. 2012;153:1932–1938. doi: 10.1016/j.pain.2012.06.006.
    1. Pinhas-Hamiel O., Frumin K., Gabis L., Mazor-Aronovich K., Modan-Moses D., Reichman B., Lerner-Geva L. Headaches in overweight children and adolescents referred to a tertiary-care center in Israel. Obesity. 2008;16:659–663. doi: 10.1038/oby.2007.88.
    1. Katzmarzyk P.T., Barlow S., Bouchard C., Catalano P.M., Hsia D.S., Inge T.H., Lovelady C., Raynor H., Redman L.M., Staiano A.E., et al. An evolving scientific basis for the prevention and treatment of pediatric obesity. Int. J. Obes. 2014;38:887–905. doi: 10.1038/ijo.2014.49.
    1. Shultz S.P., Anner J., Hills A.P. Paediatric obesity, physical activity and the musculoskeletal system. Obes. Rev. 2009;10:576–582. doi: 10.1111/j.1467-789X.2009.00587.x.
    1. Nantel J., Mathieu M.E., Prince F. Physical activity and obesity: Biomechanical and physiological key concepts. J. Obes. 2011 doi: 10.1155/2011/650230.
    1. Nantel J., Brochu M., Prince F. Locomotor strategies in obese and non-obese children. Obesity. 2006;14:1789–1794. doi: 10.1038/oby.2006.206.
    1. Wang M.Y., Greendale G.A., Yu S.S., Salem G.J. Physical-Performance Outcomes and Biomechanical Correlates from the 32-Week Yoga Empowers Seniors Study. Evid. Based Complement. Alternat. Med. 2016 doi: 10.1155/2016/6921689.
    1. Zettergren K.K., Lubeski J.M., Viverito J.M. Effects of a yoga program on postural control, mobility, and gait speed in community-living older adults: A pilot study. J. Geriatr. Phys. Ther. 2011;34:88–94. doi: 10.1519/JPT.0b013e31820aab53.
    1. DiBenedetto M., Innes K.E., Taylor A.G., Rodeheaver P.F., Boxer J.A., Wright H.J., Kerrigan D.C. Effect of a gentle Iyengar yoga program on gait in the elderly: An exploratory study. Arch. Phys. Med. Rehabil. 2005;86:1830–1837. doi: 10.1016/j.apmr.2005.03.011.
    1. Hainsworth K.R., Salamon K.S., Stolzman S.C., Simpson P.M., Esliger D.W., Mascarenhas B., Liu X.C., Khan K.A., Weisman S.J. Hatha yoga for pediatric obesity: A pilot study. J. Yoga Phys. Ther. 2014;4 doi: 10.41/2157-7595.1000172.
    1. Bernstein A.M., Bar J., Ehrman J.P., Golubic M., Roizen M.F. Yoga in the Managment of Overweight and Obesity. Am. J. Lifestyle Med. 2013 doi: 10.1177/1559827613492097.
    1. Shultz S.P., Hills A.P., Sitler M.R., Hillstrom H.J. Body size and walking cadence affect lower extremity joint power in children’s gait. Gait Posture. 2010;32:248–252. doi: 10.1016/j.gaitpost.2010.05.001.
    1. Shultz S.P., Browning R.C., Schutz Y., Maffeis C., Hills A.P. Childhood obesity and walking: Guidelines and challenges. Int. J. Pediatr. Obes. 2011;6:332–341. doi: 10.3109/17477166.2011.590202.
    1. Shultz S.P., Sitler M.R., Tierney R.T., Hillstrom H.J., Song J. Consequences of pediatric obesity on the foot and ankle complex. J. Am. Podiatr. Med. Assoc. 2012;102:5–12. doi: 10.7547/1020005.
    1. Shultz S.P., Sitler M.R., Tierney R.T., Hillstrom H.J., Song J. Effects of pediatric obesity on joint kinematics and kinetics during 2 walking cadences. Arch. Phys. Med. Rehabil. 2009;90:2146–2154. doi: 10.1016/j.apmr.2009.07.024.
    1. Blakemore V.J., Fink P.W., Lark S.D., Shultz S.P. Mass affects lower extremity muscle activity patterns in children’s gait. Gait Posture. 2013;38:609–613. doi: 10.1016/j.gaitpost.2013.02.002.
    1. Shultz S.P., D’Hondt E., Lenoir M., Fink P.W., Hills A.P. The role of excess mass in the adaptation of children’s gait. Hum. Mov. Sci. 2014;36:12–19. doi: 10.1016/j.humov.2014.05.002.
    1. Chan G., Chen C.T. Musculoskeletal effects of obesity. Curr. Opin. Pediatr. 2009;21:65–70. doi: 10.1097/MOP.0b013e328320a914.
    1. Armstrong S., Lazorick S., Hampl S., Skelton J.A., Wood C., Collier D., Perrin E.M. Physical Examination Findings among Children and Adolescents with Obesity: An Evidence-Based Review. Pediatrics. 2016;137 doi: 10.1542/peds.2015-1766.
    1. Rioux J.G., Ritenbaugh C. Narrative review of yoga intervention clinical trials including weight-related outcomes. Altern. Ther. Health Med. 2013;19:32–46.
    1. Gothe N.P., McAuley E. Yoga Is as Good as Stretching-Strengthening Exercises in Improving Functional Fitness Outcomes: Results from a Randomized Controlled Trial. J. Gerontol. Ser. A Biol. Sci. Med. Sci. 2016;71:406–411. doi: 10.1093/gerona/glv127.
    1. Patel N.K., Newstead A.H., Ferrer R.L. The effects of yoga on physical functioning and health related quality of life in older adults: A systematic review and meta-analysis. J. Altern. Complement. Med. 2012;18:902–917. doi: 10.1089/acm.2011.0473.
    1. Yang K., James K.A. Yoga, as a transitional platform to more active lifestyle: A 6-month pilot study in the USA. Health Promot. Int. 2016;31:423–429. doi: 10.1093/heapro/dau108.
    1. Wren A.A., Wright M.A., Carson J.W., Keefe F.J. Yoga for persistent pain: New findings and directions for an ancient practice. Pain. 2011;152:477–480. doi: 10.1016/j.pain.2010.11.017.
    1. Evans S., Sternlieb B., Zeltzer L., Tsao J. Iyengar yoga and the use of props for pediatric chronic pain: A case study. Altern. Ther. Health Med. 2013;19:66–70.
    1. Evans S., Moieni M., Subramanian S., Tsao J.C., Sternlieb B., Zeltzer L.K. “Now I see a brighter day”: Expectations and perceived benefits of an Iyengar yoga intervention for young patients with rheumatoid arthritis. J. Yoga Phys. Ther. 2011;1 doi: 10.4172/2157-7595.1000101.
    1. Evans S., Moieni M., Lung K., Tsao J., Sternlieb B., Taylor M., Zeltzer L. Impact of Iyengar Yoga on Quality of Life in Young Women with Rheumatoid Arthritis. Clin. J. Pain. 2013;29:988–997. doi: 10.1097/AJP.0b013e31827da381.
    1. Evans S., Moieni M., Sternlieb B., Tsao J.C., Zeltzer L.K. Yoga for youth in pain: The UCLA pediatric pain program model. Holist. Nurs. Pract. 2012;26:262–271. doi: 10.1097/HNP.0b013e318263f2ed.
    1. Evans S., Tsao J., Zeltzer L. Iyengar yoga for pediatric chronic pain. Pediatr. Pain Lett. 2009;11:12–16.
    1. Wearing S.C., Henning E.M., Byrne N.M., Steele J.R., Hills A.P. The impact of childhood obesity on musculoskeletal form. Obes. Rev. 2006;7:209–218. doi: 10.1111/j.1467-789X.2006.00216.x.
    1. Shultz S.P., Byrne N.M., Hills A.P. Musculoskeletal Function and Obesity: Implications for Physical Activity. Curr. Obes. Rep. 2014;3:355–360. doi: 10.1007/s13679-014-0107-x.
    1. Shultz S.P., D’Hondt E., Fink P.W., Lenoir M., Hills A.P. The effects of pediatric obesity on dynamic joint malalignment during gait. Clin. Biomech. 2014;29:835–838. doi: 10.1016/j.clinbiomech.2014.05.004.
    1. McGraw B., McClenaghan B.A., Williams H.G., Dickerson J., Ward D.S. Gait and postural stability in obese and nonobese prepubertal boys. Arch. Phys. Med. Rehabil. 2000;81:484–489. doi: 10.1053/mr.2000.3782.
    1. Skelton J.A., DeMattia L.G., Flores G. A pediatric weight management program for high-risk populations: A preliminary analysis. Obesity. 2008;16:1698–1701. doi: 10.1038/oby.2008.243.
    1. McClelland J.A., Webster K.E., Grant C., Feller J. Alternative modelling procedures for pelvic marker occlusion during motion analysis. Gait Posture. 2010;31:415–419. doi: 10.1016/j.gaitpost.2010.01.004.
    1. Zeltzer L.K., Tsao J.C., Stelling C., Powers M., Levy S., Waterhouse M. A phase I study on the feasibility and acceptability of an acupuncture/hypnosis intervention for chronic pediatric pain. J. Pain Symptom Manag. 2002;4:437–446. doi: 10.1016/S0885-3924(02)00506-7.
    1. Varni J.W., Seid M., Kurtin P.S. PedsQL 4.0: Reliability and validity of the Pediatric Quality of Life Inventory version 4.0 generic core scales in healthy and patient populations. Med. Care. 2001;39:800–812. doi: 10.1097/00005650-200108000-00006.
    1. Varni J.W., Burwinkle T.M., Seid M., Skarr D. The PedsQL 4.0 as a pediatric population health measure: feasibility, reliability, and validity. Ambul. Pediatr. 2003;3:329–341.
    1. Von Baeyer C.L., Spagrud L.J., McCormic J.C., Choo E., Neville K., Connelly M.A. Three new datasets supporting use of the Numerical Rating Scale (NRS-11) for children’s self-reports of pain intensity. Pain. 2009;143:223–227. doi: 10.1016/j.pain.2009.03.002.
    1. Evenson K.R., Catellier D.J., Gill K., Ondrak K.S., McMurray R.G. Calibration of two objective measures of physical activity for children. J. Sports Sci. 2008;26:1557–1565. doi: 10.1080/02640410802334196.
    1. Kuczmarski R.J., Ogden C.L., Guo S.S., Grummer-Strawn L.M., Flegal K.M., Mei Z., Wei R., Curtin L.R., Roche A.F., Johnson C.L. 2000 CDC Growth Charts for the United States: Methods and development. Vital Health Stat. 2002;246:1–190.
    1. Varni J.W., Seid M., Rode C.A. The PedsQL: Measurement model for the pediatric quality of life inventory. Med. Care. 1999;37:126–139. doi: 10.1097/00005650-199902000-00003.
    1. Hainsworth K.R., Salamon K.S., Khan K.A., Mascarenhas B., Davies W.H., Weisman S.J. A pilot study of yoga for chronic headaches in youth: Promise amidst challenges. Pain Manag. Nurs. 2014;15:490–498. doi: 10.1016/j.pmn.2012.12.002.
    1. Springer B.D., Carter J.T., McLawhorn A.S., Scharf K., Roslin M., Kallies K.J., Morton J.M., Kothari S.N. Obesity and the role of bariatric surgery in the surgical management of osteoarthritis of the hip and knee: A review of the literature. Surg. Obes. Relat. Dis. 2017;13:111–118. doi: 10.1016/j.soard.2016.09.011.
    1. Steinberg N., Rubinstein M., Nemet D., Ayalon M., Zeev A., Pantanowitz M., Brosh T., Eliakim A. Effects of a Program for Improving Biomechanical Characteristics during Walking and Running in Children Who Are Obese. Pediatr. Phys. Ther. 2017;29:330–340. doi: 10.1097/PEP.0000000000000440.
    1. Delextrat A., Matthew D., Brisswalter J. Exercise training modifies walking kinematics and energy cost in obese adolescents: A pilot controlled trial. Eur. J. Sport Sci. 2015;15:727–735. doi: 10.1080/17461391.2015.1061058.
    1. Wang M.Y., Yu S.S., Hashish R., Samarawickrame S.D., Kazadi L., Greendale G.A., Salem G. The biomechanical demands of standing yoga poses in seniors: The Yoga empowers seniors study (YESS) BMC Complement. Altern. Med. 2013:13. doi: 10.1186/1472-6882-13-8.
    1. Wang M.Y., Yu S.Y., Hashish R., Samarawickrame S., Haines M., Mulwitz L., Kazadi L., Greendale G., Salem G. Biomechanical demands of therapeutic hatha yoga poses in older adults: Modified chair and downward facing dog; Proceedings of the Annual meeting of American society of biomechanics; Long Beach, CA, USA. 10–13 August 2011.
    1. DeVita P., Rider P., Hortobagyi T. Reductions in knee joint forces with weight loss are attenuated by gait adaptations in class III obesity. Gait Posture. 2016;45:25–30. doi: 10.1016/j.gaitpost.2015.12.040.
    1. Riazi A., Shakoor S., Dundas I., Eiser C., McKenzie S.A. Health-related quality of life in a clinical sample of obese children and adolescents. Health Qual. Life Outcomes. 2010;8 doi: 10.1186/1477-7525-8-134.
    1. Ross A., Brooks A., Touchton-Leonard K., Wallen G. A Different Weight Loss Experience: A Qualitative Study Exploring the Behavioral, Physical, and Psychosocial Changes Associated with Yoga That Promote Weight Loss. Evid. Based Complement. Alternat. Med. 2016 doi: 10.1155/2016/2914745.
    1. Amy Janke E., Kozak A.T. The more pain I have, the more I want to eat: Obesity in the context of chronic pain. Obesity. 2012;20:2027–2034. doi: 10.1038/oby.2012.39.

Source: PubMed

Patrocinadores y Colaboradores

Condiciones médicas

Intervenciones de drogas

3
Suscribir