‘Obesity & Immobility’: Which is the Chicken & Which is the Egg?’
Addressing Obesity in Conjunction with Mobility Issues & Limitations
- By Simon Griffin
Obesity Levels
Globally, obesity levels are rising.
Increased obesity has been directly linked to:
Type 2 diabetes
High blood pressure
Stroke
Cancer
Sleep apnea
Osteoarthritis
Fatty liver disease/Galbladder disease/Kidney disease/Coronary heart disease
Pregnancy problems
Depression/Anxiety
alongside Immobility, Postural and Bio-Mechanical Issues
Obesity in Ireland
According to the HSE, 37% of Irish people have a healthy body weight.
While, 37% of Irish people are overweight,
And between 23-25% or 1 in 4 Irish adults are considered obese.
31% of men aged 15-24 are overweight or obese, compared to 27% of women of this age category.
32% of the population are considered to be sufficiently active to meet the national guidelines
40% of men are sufficiently active to meet the national guidelines compared to 24% of women.
Obesity, Immobility and Health Related Quality of Life (HRQoL)
Forhan & Gill have highlighted the direct correlation between rising obesity levels and decreasing mobility levels, and have also examined how higher levels of obesity, coupled with lower levels of mobility leads to a poor ‘health related quality of life’ (HRQoL).
Can immobility impede weightloss?
Forhan & Gill argued that ‘
patients with obesity are routinely advised by their health care provider to become more physically active for the purpose of losing weight and reducing cardiovascular and metabolic risk.
Although such advice is well intended to promote health and wellness, changes to physical activity levels and the associated benefits are illusive unless issues related to functional mobility are addressed.
If a patient with obesity is not able to move around at an intensity and frequency required to lose weight or prevent weight gain they are at greater risk of experiencing mobility issues.
Those patients with impaired mobility will continue to experience restrictions in activities at home, work, school and in the community thereby having a negative impact on their health related quality of life (HRQoL).
So, short answer: YES
Mike Boyle & Gray Cook’s Joint by Joint Approach argues that wherever pain is located in the body, the answer to the problem is usually found in either the joint above or below the area of pain.
Each Joint’s Primary Need through the lens of Mobility & Stability
Gleno-humeral– Mobility
Scapula – Stability
Thoracic Spine–Mobility
Lumbar Spine – Stability
Hip – Mobility (multi-planar)
Knee – Stability
Ankle –Mobility (sagittal)
Mike Boyle & Gray Cook’s Joint by Joint Approach
Joints which lose mobility:
Declining activity levels will directly affect the mobility of these 3 joints
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Hip Immobility
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Thoracic Spine Immobility
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Gleno-humeral Immobility
Joints which lose stability:
Declining activity levels will directly affect the stability of these 3 joints
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Knee Instability
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Lumbar Instability
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Scapula Instability
Motor Unit Recruitment & Full Range of Motion
Dr John Rusin argues that loading the body’s joints through their full range of motion (RoM) produces the most optimal muscular reaction within the body.
This hypothesis can be analysed through the use of an Electromyography Assessment (EMG), which calculates the Motor Unit Recruitment (MUR) (the muscle mass utilised during any given motion).
François Billaut of the Victoria University, Australia subsequently tested and confirmed this hypothesis which proved that both high intensity exercises, utilising the body’s full range of motions through each respective joint, produced the largest muscular reaction in the body.
Taking Rusin & Billaut’s work into account, in conjunction with Brad Schoenfeld’s research which highlighted that “intensity (i.e. load)… is arguably the most important exercise variable for stimulating muscle growth’’, we can confirm that it is far more difficult for someone with mobility issues to successfully manage excess body fat, maintain joint integrity and adequate muscle mass standards.
So, practically, how does immobility or bio-mechanical issues impede weight-loss?
When we look at any given compound exercise in the gym, we are looking for a full range of motion to recruit/utilise as many muscles as possible to perform the given exercise.
If a client, or trainee cannot access the full range of motion while maintaining correct joint alignment, then the muscles involved cannot be utilised, or fatigued sufficiently or safely to bring about sufficient muscular reaction to cause weight-loss.
The depth of a clients squat is a prime example of a mobility issue that can arise during training. The higher the squat, the less muscles recruited surrounding the hip capsule, thereby lessening the muscular impact of the exercise, in this case, a squat.
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12 inch box plus gray plate
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12 inch box plus green plate
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12 inch box plus yellow plate
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12 inch box plus blue plate
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12 inch box plus blue & gray plate
Barbell Back Squat Vs Barbell Back Box Squat
Barbell Back Squat
Full Range of Motion (RoM)
Barbell Back Box Squat
Partial Range of Motion (RoM)
Kubo et. al (2019) examined the muscular impact of different squat depth by examining two different categories of athletes.
This study compared the effect of squatting with either full depth (140 degrees of knee flexion) or half depth (90 degrees of knee flexion) on muscle volume of the quadriceps, hamstrings, gluteus maximus, and hip adductors.
17 untrained subjects were randomly assigned to the full-squat or half-squat group, and squatted 2 times per week for 10 weeks. Subjects performed 3 sets each session at 80-90% of their 1RM. Training load was progressed by 5kg once subjects could perform 3 sets of 8 reps.
The researchers found that the full-squat group experienced significantly greater increases in muscle volume of the glutes and adductors compared to the half-squat group.
Conventional Deadlift Vs Sumo Deadlift
Escamilla et. al. examined the Motor Unit Recruitment via an EMG and concluded that ‘overall EMG activity from the vastus medialis (quad muscle), vastus lateralis (quad muscle), and tibialis anterior (shin) were significantly greater in the sumo deadlift, whereas overall EMG activity from the medial gastrocnemius (calf) was significantly greater in the conventional deadlift.’
Often trainers/coaches will prioritise one type of deadlift over the other due to mobility limitations. Escamilla et, al. has highlighted that the exercises chosen due to possible mobility limitations do in fact have a muscular impact for better or worse on the body, thereby confirming that mobility limitations have a significant impact on a clients ability to lose weight successfully.
Conventional Barbell Deadlift
Less Knee Flexion (than Barbell Sumo Deadlift)
Barbell Sumo Deadlift
More knee flexion (than Conventional Barbell Deadlift)
Additional Research supporting Full Range of Motion Training
Silva and Schoenfeld proved that changes in range of motion affect the magnitude of the load during a squat which consequently influences muscle activation.
Additionally, Conteras and Schoenfeld further argued that ‘it is recommended that individuals use a full range of motion when squatting, assuming full range can be safely achieved, to promote more favorable training adaptations.’
Walking Gait & Obesity
Walking Gait is the pattern that you walk in.
Gait Analysis - An analysis of each component of the three phases of ambulation (heel strike, mid stance, toe-off).
The Gait Cycle
The sequences for walking that occur may be summarised as follows:
Registration and activation of the gait command within the central nervous system.
Transmission of the gait systems to the peripheral nervous system.
Contraction of muscles.
Generation of several forces.
Regulation of joint forces and moments across synovial joints and skeletal segments.
Generation of ground reaction forces.
Stance & Swing Phase
The normal forward step consists of two phases: stance phase; swing phase,
The Stance phase occupies 60% of the gait cycle, during which one leg and foot are bearing most or all of the bodyweight
The Swing phase occupies only 40% of it, during which the foot is not touching the walking surface and the bodyweight is borne by the other leg and foot.
In a complete two-step cycle both feet are in contact with the floor at the same time for about 25 per cent of the time. This part of the cycle is called the double-support phase.
Gait cycle phases: the stance phase and the swing phase and involves a combination of open and close chain activities.
Walking Gait & Obesity
P.K. Lai & K.L. Leung et. al analysed to what extent obesity had an impact on walking gait.
Group A - Obese
Group B - Healthy
The obese group walked slower and had a shorter stride length. They also spent more time on stance phase and double support in walking. Greater hip adduction was shown in the obese group during terminal stance and pre-swing. The maximum knee adduction angles of the obese group in both stance and swing phases were significantly higher. The ankle eversion angle of the obese group was significantly higher from mid stance to pre-swing. There were reduction of peak ankle plantar flexor moment, and increase of ankle inversion moment.
In conclusion
It can be difficult to say which truly came first, decreasing mobility levels of increasing obesity levels.
With each client or trainee, the answer will tend to differ.
However, there is little doubt that mobility issues must be addressed if a client wishes to see successful weight-loss results, improved joint health, increased muscle mass and better pain prevention or management as movement and mobility is ultimately the baseline of all athletic exercises.
Thank you for listening!
But, just a final minute of your attention:
I set up 360Movement as I was fed up with the declining state of the fitness industry which has always been more interested in selling quick fixes and short cuts to those who ultimately need help, information, support and an individual approach to their own health and fitness.
Over the past 4 seminars, I have attempted to disseminate accurate information to you, in the hope that with more information, you can progress further and more successfully with your own training.
If you enjoyed these seminars, please be kind enough to leave me positive Google Review here.
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