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IJCRR - 4(5), March, 2012

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INFLUENCE OF BODY MASS INDEX ON BALANCE IN SITTING AND STANDING

Author: A.Kumaresan, S.Prathap, Vaiyapuri Anandh

Category: Healthcare

Abstract:Background and Objective: Functional reach test is used for assessing the dynamic balance. It
is defined as a maximal distance one can reach forward beyond arm?s length while aintaining a fixed (BOS) Base of Support in the standing position. The biomechanical activities of daily living are into mechanical and neuromuscular factors that may predispose the obese to injury. A better appreciation of the implications of increased levels of body adiposity on the movement capabilities of the obese would afford a greater opportunity to provide meaningful support in preventing, treating and managing the condition and its sequelae. Reaching forward in sitting is a challenge to a person?s postural control and is suggested to be an indicator of sitting balance.
Functional reach test is easy to assess the dynamic balance. It is portable, inexpensive, reliable,
precise and less time consuming for detecting dynamic balance. This study intends to analyze
the effect of various BMI on functional reach test during standing and sitting.
Study Design: observational study
Setting: Outpatient Department, Saveetha college of Physiotherapy, Thandalam - 602105
Outcome Measures: Quantitative parameters: Functional reach test.
Method: observational study design was used for this study. Inclusion criteria- Age: 20-30
year, Vision \? Normal/ corrected vision, Vestibular \? Pathologies are ruled out,
Musculoskeletal- Range of motion: the bilateral shoulder- ranges full (or) for to the test to be
carried smoothly. Exclusion criteria-Visual defect, History of vestibular problem, Restriction
range motion of bilateral shoulder joint. Ninety individual divided in to 3 groups according to
their BMI, each group 30 individuals. All the three groups asked to perform a standing and
sitting functional reach test after obtaining informed consent.
Result:. Group 1 mean maximal standing functional reach was 27.98 cm, ( S.D-2.98, range=
20.6-33.46), mean of sitting functional reach was 29.09 cm, (S.D-2.42, range=24.36-34.23) for
normal individual, Group 2 standing reach was 21.24 cm,(S.D-2.25, range=17.13-25.7), sitting
reach was 24.17cm,(S.D-2.44,range=19.63-29.03) for overweight individual and group 3
standing reach was 15.42cm (S.D-3.08, range=10.07-22.60), sitting reach was 18.26 cm (S.D-
2.10 ,range=14-21.73)for obese individuals. There is a significant difference in between the
groups. Conclusion: The statistical results of this study concludes that overweight and obese
individuals shows less forward functional reach when compared to the normal subjects. Post
hoc test shows that there is a highly significant difference were noticed in between the groups

Keywords: functional reach test, body mass index, forward reaching, overweight, obesity.

Full Text:

INTRODUCTION
Balance is defined as forces acting on the body are balanced such that the centre of mass (COM) is within the stability limits, Boundaries of base of support (BOS). Balance and upright postural control are fundamental components of movement, this involves both the ability to recover from instability and the ability to anticipate and move in ways to avoid instability (Shumway Cook A.1995).22 Obesity is recognized as a major health problem in many parts of the world, and the condition is escalating at alarming rate obesity has reached epidemic proportion globally with more than 1.6 billion adults are overweight and at least 40million are clinically obese and major contributed to the global burden of chronic disease and disability co-exists. Obesity is complex condition with severe social and psychological dimension, affecting virtually all ages and socio economic group (2006 WHO).32 Obesity is commonly assessed by using body mass index (BMI). It is defined as the weight in kilogram divided by square of height in meters (kg/m2 ). A BMI between 25kg/m and 29.9kg/m is defined as overweight and a BMI of greater or equal to 30kg/m as obese (WHO 2006).32 In spite of significant advances in the knowledge and understanding of the multifactorial nature of obesity, many questions regarding the specific consequences of the disease remain unanswered. In particular, there is a relative dearth of information pertaining to the functional limitations imposed by overweight and obesity. The limited number of studies till date has mainly focused on the effect of obesity on the temporospatial characteristics of walking, plantar foot pressures, muscular strength and, to a lesser extent, postural balance (Wearing, Scott C. and Henning 2006).21 The biomechanical activities of daily living are into mechanical and neuromuscular factors that may predispose the obese to injury. A better appreciation of the implications of increased levels of body adiposity on the movement capabilities of the obese would afford a greater opportunity to provide meaningful support in preventing, treating and managing the condition and its sequelae (S C Wearing et al 2006).21 Sitting balance is a prerequisite for most functional activities, such as dressing, transferring and eating in a seated position (Nicholas DS.1996).Sitting balance is defined as the ability of a person to maintain control over upright postures during forward reach without stabilization. Biomechanically, specific trunk movements have to occur to maintain postural control in sitting. When weight is shifted in any plane, the trunk responds with a movement to counteract a change in the center of gravity staying within the base of support and thereby maintaining the sitting position. (Schenkman M.1990). Dean et al 1999 stated that forward reach distance in sitting was positively associated with the magnitude of the trunk and upper arm segmental motion, as well as the active contribution of the lower limbs in healthy persons3 . Reaching forward in sitting is a challenge to a person?s postural control and is suggested to be an indicator of sitting balance.4 Functional reach test is used for assessing the dynamic balance. It is defined as a maximal distance one can reach forward beyond arm?s length while maintaining a fixed (BOS) Base of Support in the standing position (Duncan PW 1992).8 Functional reach test is easy to assess the dynamic balance. It is portable, inexpensive, reliable, precise and less time consuming for detecting dynamic balance. Normative values of functional reach test for different age groups are available (Duncan et al 1990).7 this study intends to analyze the effect of various BMI on functional reach test during standing and sitting.

METHODOLOGY
Subjects willing to participate in the study were screened for inclusion and exclusion criteria. They were explained about the safety and simplicity of the procedure and information sheet was given and their informed consent was obtained. The height and weight of each volunteer were noted for calculation of body mass index. Total of 90 subjects will be recruited based upon their BMI and they will be classified into 3 groups. Group A will contain individuals with normal weight, group B will have individuals who are overweight and group C will have individuals who are obese. A yardstick was attached to the wall which helps to record the reaching ability of the individual. Detailed procedure of functional reach test is taught and demonstrated to the subjects. Functional reach test was first performed with the subjects in standing (Figure-2). The shoulder was positioned at 90 degree flexion, elbow fully extended and hand was fisted. Then the subjects was asked to reach forward as much as they can without raising the heel and avoid trunk rotation and shoulder protraction and also ensure that the individual does not lean on the wall. The reading corresponding to the 3rd metacarpal were taken before and after performing functional reach test. (Figure- 3). Functional reach test was then performed with individuals in sitting (Figure-4). The subject was made to sit unsupported with the feet flat on the floor and the hip, knees, and ankles positioned in 90 degree flexion. Foot support were provided to ensure proper sitting position and asked the individual to reach forwards. The position of the shoulder was 90 degree flexion, elbow fully extended and wrist fisted. The reading corresponding to the 3rd metacarpal was taken before and after performing functional reach test. (Figure-5). Three trials were performed is each test and the average was calculated.

DATA ANALYSIS AND RESULTS
Functional reach test was performed in standing and sitting position in 30 normal, 30 overweight, 30 obese individual. The data collected were for the age group of 20- 30 yrs. The data was used to calculate the mean of the Functional reach test in forward reach direction. Group 1 mean maximal standing functional reach was 27.98 cm, ( S.D-2.98, range= 20.6-33.46), mean of sitting functional reach was 29.09 cm, (S.D-2.42, range=24.36-34.23) for normal individual, Group 2 standing reach was 21.24 cm,(S.D-2.25, range=17.13-25.7), sitting reach was 24.17cm,(S.D-2.44,range=19.63- 29.03) for overweight individual and group 3 standing reach was 15.42cm (S.D-3.08, range=10.07-22.60), sitting reach was 18.26 cm (S.D- 2.10 ,range=14-21.73)for obese individuals.(Table-1&4) A ONE WAY ANOVA, was used to determine that normal individual had a longer reach compared with overweight and same way overweight individuals had a longer reach when compared with obese individuals.(Table-2&5). POST HOC TEST was used to determine the comparison in standing functional reach test in between the groups. (P-.000),and comparison in sitting functional reach test in between the groups. (P-.000). there was a significant difference in between the groups. (Table-3&6).

DISCUSSION According to WHO obesity is a complex condition with social and psychological dimensions affecting virtually all ages and socio economic group and also a major contributor to the global burden of chronic disease and disability co-exist. (WHO 2006)32.Currently more than 1.6 billion adults are overweight and at least 400 million of them clinically obese (WHO 2006)32 . The main finding from the present study indicates that balance is influenced by varying BMI. Obese individual shows less standing and sitting functional reach values, when compared to the normal and overweight subjects, overweight individual?s shows less standing and sitting functional reach values when compared to the normal. Statistical Data Analysis proved that there is highly significant difference which exist between the normal and overweight groups in performing standing and sitting Functional Reach Test. (P<0.000), which supported the hypothesis of this study. Forward reach in a standing and sitting position can be measured reliably via a Ruler attached to a wall along the side of the normal, overweight, obese individuals. In this study interrater reliability is weak because only one Rater was available for data collection. Further study using an Interarater design may allow inferences to be generalized to a greater number of situations. Functional Reach test appears to be useful for determining differences in Reach between each groups. This finding appears to be good among various levels of BMI. (Normal, Overweight, Obese). The Functional Reach Test measured reasonable because of their BMI values. In obese and overweight groups there is a high BMI value and less functional reach values in sitting and standing position. The subjects in obese and overweight groups had decreased standing and sitting functional reach distance which can be attributed by decreased muscle activity in lower extremity due to reduced oxidative capacity resulting in decreased force and endurance protection as stated by (orbeil et al. 2001). This same assumption is also supported by (hulens et al. 2001) he states that muscle activity in lower extremity reduces due to altered metabolic state in obesity, overweight individuals.15 Individual body size and shape influenced the static postural stability by altering the location of the centre of gravity as stated by (fregly et al.1968).10 . In this study comparison is made between the normal, overweight and obese individuals BMI (body mass index) and their functional reach values. Then comparison was done in standing and sitting functional reach values in between the groups. The study done in the adult population between 20-30yrs of age, they were analyzed and concluded that whenever BMI increases the forward functional reach decreases significantly. As Duncan et al (1990) studied on normal individuals for arriving at normative functional reach values6 . It could be difficult to use these values for the comparison of overweight and obese individuals undergoing neurological rehabilitation. This study analyzed the relationship between BMI and functional reach values. The result will be helpful in arriving reference point to be used for balance rehabilitation for overweight and obese individuals in 20-30yrs of age group. If normative value has been standardized for overweight and obese individuals of different age groups in large sample size it can be used in the neurological rehabilitation program to set a realistic goal. Further studies can be done with all the groups in overweight and obese subjects also who are not considered in this study.

CONCLUSION
The statistical results of this study concludes that overweight and obese individuals shows less forward functional reach when compared to the normal subjects. Post hoc test shows that there was highly significant differences were noticed in between the groups. The functional reach test, a useful test because it is easy and fast to perform and adaptable to many environment. The purpose of this study was to test whether the functional reach test would provide reliable measurements in persons with normal overweight and obese individuals in the age group of 20-30 yrs.(Figure-1)

ACKNOWLEDGEMENT Authors acknowledge the immense help received from the scholars whose articles are cited and included in references of this manuscript. The authors are also grateful to authors/editors/publishers of all those articles, journals and books from where the literature for this article has been reviewed and discussed.

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A Study by Avijit Singh"Comparison of Post Operative Clinical Outcomes Between “Made in India” TTK Chitra Mechanical Heart Valve Versus St Jude Mechanical Heart Valve in Valve Replacement Surgery" is awarded Best Article for Vol 12 issue 19

A Study by Sonali Banerjee and Mary Mathews N. entitled "Exploring Quality of Life and Perceived Experiences Among Couples Undergoing Fertility Treatment in Western India: A Mixed Methodology" is awarded Best Article for Vol 12 issue 18

A Study by Jabbar Desai et al. entitled "Prevalence of Obstructive Airway Disease in Patients with Ischemic Heart Disease and Hypertension" is awarded Best Article for Vol 12 issue 17

A Study by Juna Byun et al. entitled "Study on Difference in Coronavirus-19 Related Anxiety between Face-to-face and Non-face-to-face Classes among University Students in South Korea" is awarded Best Article for Vol 12 issue 16

A Study by Sudha Ramachandra & Vinay Chavan entitled "Enhanced-Hybrid-Age Layered Population Structure (E-Hybrid-ALPS): A Genetic Algorithm with Adaptive Crossover for Molecular Docking Studies of Drug Discovery Process" is awarded Best article for Vol 12 issue 15

A Study by Varsha M. Shindhe et al. entitled "A Study on Effect of Smokeless Tobacco on Pulmonary Function Tests in Class IV Workers of USM-KLE (Universiti Sains Malaysia-Karnataka Lingayat Education Society) International Medical Programme, Belagavi" is awarded Best article of Vol 12 issue 14, July 2020

A study by Amruta Choudhary et al. entitled "Family Planning Knowledge, Attitude and Practice Among Women of Reproductive Age from Rural Area of Central India" is awarded Best Article for special issue "Modern Therapeutics Applications"

A study by Raunak Das entitled "Study of Cardiovascular Dysfunctions in Interstitial Lung Diseas epatients by Correlating the Levels of Serum NT PRO BNP and Microalbuminuria (Biomarkers of Cardiovascular Dysfunction) with Echocardiographic, Bronchoscopic and HighResolution Computed Tomography Findings of These ILD Patients" is awarded Best Article of Vol 12 issue 13

A Study by Kannamani Ramasamy et al. entitled "COVID-19 Situation at Chennai City – Forecasting for the Better Pandemic Management" is awarded best article for Vol 12 issue 12

A Study by Muhammet Lutfi SELCUK and Fatma entitled "Distinction of Gray and White Matter for Some Histological Staining Methods in New Zealand Rabbit's Brain" is awarded best article for Vol 12 issue 11

A Study by Anamul Haq et al. entitled "Etiology of Abnormal Uterine Bleeding in Adolescents – Emphasis Upon Polycystic Ovarian Syndrome" is awarded best article for Vol 12 issue 10

A Study by entitled "Estimation of Reference Interval of Serum Progesterone During Three Trimesters of Normal Pregnancy in a Tertiary Care Hospital of Kolkata" is awarded best article for Vol 12 issue 09

A Study by Ilona Gracie De Souza & Pavan Kumar G. entitled "Effect of Releasing Myofascial Chain in Patients with Patellofemoral Pain Syndrome - A Randomized Clinical Trial" is awarded best article for Vol 12 issue 08

A Study by Virendra Atam et. al. entitled "Clinical Profile and Short - Term Mortality Predictors in Acute Stroke with Emphasis on Stress Hyperglycemia and THRIVE Score : An Observational Study" is awarded best article for Vol 12 issue 07

A Study by K. Krupashree et. al. entitled "Protective Effects of Picrorhizakurroa Against Fumonisin B1 Induced Hepatotoxicity in Mice" is awarded best article for issue Vol 10 issue 20

A study by Mithun K.P. et al "Larvicidal Activity of Crude Solanum Nigrum Leaf and Berries Extract Against Dengue Vector-Aedesaegypti" is awarded Best Article for Vol 10 issue 14 of IJCRR

A study by Asha Menon "Women in Child Care and Early Education: Truly Nontraditional Work" is awarded Best Article for Vol 10 issue 13

A study by Deep J. M. "Prevalence of Molar-Incisor Hypomineralization in 7-13 Years Old Children of Biratnagar, Nepal: A Cross Sectional Study" is awarded Best Article for Vol 10 issue 11 of IJCRR

A review by Chitra et al to analyse relation between Obesity and Type 2 diabetes is awarded 'Best Article' for Vol 10 issue 10 by IJCRR.

A study by Karanpreet et al "Pregnancy Induced Hypertension: A Study on Its Multisystem Involvement" is given Best Paper Award for Vol 10 issue 09

List of Awardees

A Study by Ese Anibor et al. "Evaluation of Temporomandibular Joint Disorders Among Delta State University Students in Abraka, Nigeria" from Vol 13 issue 16 received Emerging Researcher Award

A Study by Alkhansa Mahmoud et al. entitled "mRNA Expression of Somatostatin Receptors (1-5) in MCF7 and MDA-MB231 Breast Cancer Cells" from Vol 13 issue 06 received Emerging Researcher Award

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