Morbid Obesity
Conditions
Keywords
Tai Chi, physical activity, morbid obesity
Brief summary
This study investigated the use of Tai Chi as a feasible form of physical activity for women with morbid obesity utilizing an instructional digital video disc (DVD). Two groups of women with morbid obesity (body mass index of \>40) were placed into the Tai Chi intervention group or the control group. Initial function was assessed with a series of tests and then repeated after 8 weeks. During the 8 weeks, the Tai Chi intervention group met once a week for 45 minutes to participate in a group exercise class. The control group was asked to continue their regular activity. At the end of the 8 weeks, both groups were reassessed with the same tests from the start of the study. The investigators hypothesized that the Tai Chi group would show more improvement in their functional scores for strength, balance and quality of life than the control group.
Detailed description
The purpose of this study was to investigate an alternative approach to physical activity in people who are morbidly obese to improve their overall health, functional mobility, and quality of life. Although physical activity is recommended in most weight management programs, the type of physical activity that results in the most successful outcomes has not been determined. Walking programs are among the most common forms recommended, however few parameters or guidelines are provided, and well-controlled comparisons to other types of exercise are lacking. Compliance with exercise programs is also a factor that impacts success, therefore offering solutions that improve compliance would be beneficial as well. This study investigated the use of home-based exercise enhanced with DVDs along with weekly, supervised group sessions to compare Tai Chi to a walking program in participants who are morbidly obese. The participants were recruited from the community with the requirement that they have a body mass index of \>40 and have a diagnosis of morbid obesity. A falls risk screening, the Four Square Step Test (FSST), was performed on which they must score as a low fall risk. A battery of physical and paper tests will be completed prior to starting the study to assess balance, endurance, functional lower extremity strength, and quality of life. Both groups completed a self-report of their weekly physical activity that was submitted on an Activity Log. Those who were designated to be in the control group did not have any additional interaction with the study until week 10 when they returned for post-testing. The Tai Chi intervention group met one time per week as a group to practice Tai Chi with the DVD as the guide. Physical therapy students and faculty were present at each session to modify and supervise as needed. The intervention group also followed the DVD in the home setting for 2 additional sessions each week. Following the 8 weeks of structured classes and home activity, the participants returned the following week for the post-testing session.
Interventions
OTHERTai Chi
Physical activity requiring slow, controlled whole body movement and weight shifting.
Sponsors
Husson University
Study design
Allocation
NON_RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
SINGLE (Outcomes Assessor)
Masking description
Data was de-identified prior to analysis.
Intervention model description
Pretest-posttest control group design: The groups were determined by convenience sample due to the time-sensitive need to form the exercise groups. There were two arms of the study that aligned with two concurrent academic years. The first six participants to express interest were placed in the first Tai Chi intervention group. The next three participants were in the first control group. The second arm of the study had five participants who made contact before the second exercise group began. The second control group had three participants.
Eligibility
Sex/Gender
FEMALE
Age
21 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Body mass index greater than 40 * Completion of the four square step test in less than 15 seconds.
Exclusion criteria
* History of neurological insult or disease * Cardiac condition limiting exercise * Joint pain severely limiting movement * Major surgery within 6 months
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Four Square Step Test | 10 weeks | Three-quarter inch diameter plastic tubing was placed on the ground to form a plus sign. The participant was required to step as fast as possible starting in square 1 in a clockwise direction and then returning counterclockwise making full contact in each square with both feet and not touching the tubing. The participants were required to complete the Four Square Step Test in 15 seconds or less in order to be included in the study based on the research that a time longer than 15 seconds is predictive of multiple falls. The results were compared at the conclusion of the study as an indicator of balance. |
| Zeno Walkway Analysis of Gait Speed | 10 weeks | Participants were asked to walk along the gait mat for a total of four passes. A piece of tape was placed one meter before and after the gait mat. Participants were instructed to turn around once they reached the piece of tape to decrease the effects of acceleration and deceleration on the gait mat. Data collected on the Protokinetics Zeno Walkway included the participants' gait speed. |
| 36-item Short Form Health Survey (SF-36) | 10 weeks | The SF-36 was used to measure how each participant viewed their physical and mental health. The questionnaire contained sections that covered vitality, physical functioning, bodily pain, general health perceptions, physical role functioning, emotional role functioning, social role functioning, and mental health. Overall, the SF-36 has the ability to measure the well-being of older adults . Scores on the SF-36 range from 0-700, with a lower score identifying greater disability and a higher score suggesting less disability. |
| Six Minute Walk Test (6MWT) | 10 weeks | The 6MWT is a submaximal test of endurance measuring total distance walked in six minutes. A 100 foot walking path was measured down a level, hard surfaced hallway. The participant was asked to repeatedly walk the complete length of the 100 foot walking path as many times as possible in six minutes at a comfortable pace. The participant was allowed to rest during this test, however, the timer did not stop until the six minute time frame had been completed. The total distance upon completion of the 6MWT was documented. |
| 30 Second Sit to Stand | 10 weeks | The 30 Second Sit to Stand is a test of lower extremity functional strength. This test consists of rising from a standard height chair and returning to sitting as many times as the person is able to within 30 seconds without the use of their upper extremities. It is a measure of lower extremity functional strength. |
| Timed up and go Test | 10 weeks | The Timed Up and Go test (TUG) begins with the participant seated in an armchair. The participant is instructed to stand up and walk at a comfortable pace to a mark three meters in front of the chair, turn around, walk back to the chair, and sit down. The test is timed, and participants are allowed to use the arms of the chair and an assistive device if they choose. This assessment correlates with fall risk and functional mobility. |
| Single Leg Stance Test | 10 weeks | The Single Leg Stance test (SLS) test measures static balance while standing on one leg, with a longer time indicating better balance ability. A participant would stand on one leg and hold the position as long as they could up to 30 seconds. Participants were required to perform 3 trials with eyes open and 3 trials with eyes closed on both limbs. The longest of the three trials was used for data analysis. The timer was stopped in the following situations: (1) the foot of the non-stance leg touched the floor, (2) the lower extremities made contact with each other, (3) the participant exceeded 30 seconds of single leg stance, or (4) the participant opened their eyes on the eyes closed trial. |
Participant flow
Participants by arm
| Arm | Count |
|---|---|
| Tai Chi Intervention The intervention group received Tai Chi instruction via a weekly group session and home use of a DVD for a period of 8 weeks. | 7 |
| Control Group The control group received no formal instruction in physical activity. | 5 |
| Total | 12 |
Withdrawals & dropouts
| Period | Reason | FG000 | FG001 |
|---|---|---|---|
| Overall Study | Protocol Violation | 3 | 0 |
| Overall Study | Scheduling difficulties | 1 | 1 |
Baseline characteristics
| Characteristic | Total | Tai Chi Intervention | Control Group |
|---|---|---|---|
| 30 Second Sit to Stand | 13.42 repetitions STANDARD_DEVIATION 2.81 | 13.14 repetitions STANDARD_DEVIATION 2.12 | 13.80 repetitions STANDARD_DEVIATION 3.83 |
| 6 Minute Walk Test | 394.08 feet STANDARD_DEVIATION 92.06 | 416.14 feet STANDARD_DEVIATION 95.69 | 363.20 feet STANDARD_DEVIATION 86.76 |
| Age, Continuous | 51.7 years STANDARD_DEVIATION 10 | 51.6 years STANDARD_DEVIATION 10.6 | 51.8 years STANDARD_DEVIATION 10.3 |
| BMI | 47.64 kg/meters squared STANDARD_DEVIATION 4.72 | 45.93 kg/meters squared STANDARD_DEVIATION 4.9 | 50.04 kg/meters squared STANDARD_DEVIATION 3.63 |
| Four Square Step Test | 10.02 seconds STANDARD_DEVIATION 2.27 | 9.91 seconds STANDARD_DEVIATION 2.02 | 10.17 seconds STANDARD_DEVIATION 2.82 |
| Race (NIH/OMB) American Indian or Alaska Native | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Asian | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Black or African American | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) More than one race | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Native Hawaiian or Other Pacific Islander | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Unknown or Not Reported | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) White | 12 Participants | 7 Participants | 5 Participants |
| Region of Enrollment United States | 12 participants | 7 participants | 5 participants |
| Sex: Female, Male Female | 12 Participants | 7 Participants | 5 Participants |
| Sex: Female, Male Male | 0 Participants | 0 Participants | 0 Participants |
| Timed Up and Go | 9.23 seconds STANDARD_DEVIATION 1.57 | 8.62 seconds STANDARD_DEVIATION 1.27 | 10.08 seconds STANDARD_DEVIATION 1.67 |
| Weight | 273.51 pounds STANDARD_DEVIATION 26.18 | 278.36 pounds STANDARD_DEVIATION 28.95 | 266.72 pounds STANDARD_DEVIATION 23.01 |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | 0 / 7 | 0 / 5 |
| other Total, other adverse events | 0 / 7 | 0 / 5 |
| serious Total, serious adverse events | 0 / 7 | 0 / 5 |
Outcome results
Primary
30 Second Sit to Stand
The 30 Second Sit to Stand is a test of lower extremity functional strength. This test consists of rising from a standard height chair and returning to sitting as many times as the person is able to within 30 seconds without the use of their upper extremities. It is a measure of lower extremity functional strength.
Time frame: 10 weeks
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Tai Chi Intervention 1 | 30 Second Sit to Stand | Pre-test | 13.14 repetitions | Standard Deviation 2.12 |
| Tai Chi Intervention 1 | 30 Second Sit to Stand | Post-test | 13.29 repetitions | Standard Deviation 1.5 |
| Tai Chi Intervention 2 | 30 Second Sit to Stand | Pre-test | 13.80 repetitions | Standard Deviation 3.84 |
| Tai Chi Intervention 2 | 30 Second Sit to Stand | Post-test | 14.60 repetitions | Standard Deviation 2.7 |
Primary
36-item Short Form Health Survey (SF-36)
The SF-36 was used to measure how each participant viewed their physical and mental health. The questionnaire contained sections that covered vitality, physical functioning, bodily pain, general health perceptions, physical role functioning, emotional role functioning, social role functioning, and mental health. Overall, the SF-36 has the ability to measure the well-being of older adults . Scores on the SF-36 range from 0-700, with a lower score identifying greater disability and a higher score suggesting less disability.
Time frame: 10 weeks
| Arm | Measure | Group | Value (MEDIAN) |
|---|---|---|---|
| Tai Chi Intervention 1 | 36-item Short Form Health Survey (SF-36) | Overall Score, Pre Test | 586.0 score on a scale |
| Tai Chi Intervention 1 | 36-item Short Form Health Survey (SF-36) | Overall Score, Post Test | 598.5 score on a scale |
| Tai Chi Intervention 2 | 36-item Short Form Health Survey (SF-36) | Overall Score, Pre Test | 564.0 score on a scale |
| Tai Chi Intervention 2 | 36-item Short Form Health Survey (SF-36) | Overall Score, Post Test | 533.0 score on a scale |
Primary
Four Square Step Test
Three-quarter inch diameter plastic tubing was placed on the ground to form a plus sign. The participant was required to step as fast as possible starting in square 1 in a clockwise direction and then returning counterclockwise making full contact in each square with both feet and not touching the tubing. The participants were required to complete the Four Square Step Test in 15 seconds or less in order to be included in the study based on the research that a time longer than 15 seconds is predictive of multiple falls. The results were compared at the conclusion of the study as an indicator of balance.
Time frame: 10 weeks
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Tai Chi Intervention 1 | Four Square Step Test | Pre-test | 9.91 seconds | Standard Deviation 2.02 |
| Tai Chi Intervention 1 | Four Square Step Test | Post-test | 8.93 seconds | Standard Deviation 2.04 |
| Tai Chi Intervention 2 | Four Square Step Test | Pre-test | 10.17 seconds | Standard Deviation 2.82 |
| Tai Chi Intervention 2 | Four Square Step Test | Post-test | 9.50 seconds | Standard Deviation 1.74 |
Primary
Single Leg Stance Test
The Single Leg Stance test (SLS) test measures static balance while standing on one leg, with a longer time indicating better balance ability. A participant would stand on one leg and hold the position as long as they could up to 30 seconds. Participants were required to perform 3 trials with eyes open and 3 trials with eyes closed on both limbs. The longest of the three trials was used for data analysis. The timer was stopped in the following situations: (1) the foot of the non-stance leg touched the floor, (2) the lower extremities made contact with each other, (3) the participant exceeded 30 seconds of single leg stance, or (4) the participant opened their eyes on the eyes closed trial.
Time frame: 10 weeks
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Tai Chi Intervention 1 | Single Leg Stance Test | Eyes Closed, Right Pre-test | 1.95 seconds | Standard Deviation 2.23 |
| Tai Chi Intervention 1 | Single Leg Stance Test | Eyes Closed, Right Post-test | 2.22 seconds | Standard Deviation 2.32 |
| Tai Chi Intervention 1 | Single Leg Stance Test | Eyes Closed, Left Pre-test | 3.71 seconds | Standard Deviation 2.29 |
| Tai Chi Intervention 1 | Single Leg Stance Test | Eyes Closed, Left Post-test | 8.35 seconds | Standard Deviation 10.56 |
| Tai Chi Intervention 2 | Single Leg Stance Test | Eyes Closed, Left Post-test | 3.53 seconds | Standard Deviation 2.17 |
| Tai Chi Intervention 2 | Single Leg Stance Test | Eyes Closed, Right Pre-test | 3.29 seconds | Standard Deviation 2.23 |
| Tai Chi Intervention 2 | Single Leg Stance Test | Eyes Closed, Left Pre-test | 5.27 seconds | Standard Deviation 4.7 |
| Tai Chi Intervention 2 | Single Leg Stance Test | Eyes Closed, Right Post-test | 3.62 seconds | Standard Deviation 1.6 |
Primary
Six Minute Walk Test (6MWT)
The 6MWT is a submaximal test of endurance measuring total distance walked in six minutes. A 100 foot walking path was measured down a level, hard surfaced hallway. The participant was asked to repeatedly walk the complete length of the 100 foot walking path as many times as possible in six minutes at a comfortable pace. The participant was allowed to rest during this test, however, the timer did not stop until the six minute time frame had been completed. The total distance upon completion of the 6MWT was documented.
Time frame: 10 weeks
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Tai Chi Intervention 1 | Six Minute Walk Test (6MWT) | Pre-test | 126.84 meters | Standard Deviation 29.17 |
| Tai Chi Intervention 1 | Six Minute Walk Test (6MWT) | Post-test | 131.58 meters | Standard Deviation 30.81 |
| Tai Chi Intervention 2 | Six Minute Walk Test (6MWT) | Pre-test | 110.70 meters | Standard Deviation 26.45 |
| Tai Chi Intervention 2 | Six Minute Walk Test (6MWT) | Post-test | 116.52 meters | Standard Deviation 25.01 |
Primary
Timed up and go Test
The Timed Up and Go test (TUG) begins with the participant seated in an armchair. The participant is instructed to stand up and walk at a comfortable pace to a mark three meters in front of the chair, turn around, walk back to the chair, and sit down. The test is timed, and participants are allowed to use the arms of the chair and an assistive device if they choose. This assessment correlates with fall risk and functional mobility.
Time frame: 10 weeks
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Tai Chi Intervention 1 | Timed up and go Test | Pre-test | 8.62 seconds | Standard Deviation 1.27 |
| Tai Chi Intervention 1 | Timed up and go Test | Post-test | 8.07 seconds | Standard Deviation 1.51 |
| Tai Chi Intervention 2 | Timed up and go Test | Pre-test | 10.08 seconds | Standard Deviation 1.67 |
| Tai Chi Intervention 2 | Timed up and go Test | Post-test | 9.46 seconds | Standard Deviation 2.91 |
Primary
Zeno Walkway Analysis of Gait Speed
Participants were asked to walk along the gait mat for a total of four passes. A piece of tape was placed one meter before and after the gait mat. Participants were instructed to turn around once they reached the piece of tape to decrease the effects of acceleration and deceleration on the gait mat. Data collected on the Protokinetics Zeno Walkway included the participants' gait speed.
Time frame: 10 weeks
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Tai Chi Intervention 1 | Zeno Walkway Analysis of Gait Speed | Gait Speed Pre Test | 1.20 meters/second | Standard Deviation 0.14 |
| Tai Chi Intervention 1 | Zeno Walkway Analysis of Gait Speed | Gait Speed Post Test | 1.27 meters/second | Standard Deviation 0.14 |
| Tai Chi Intervention 2 | Zeno Walkway Analysis of Gait Speed | Gait Speed Pre Test | 1.07 meters/second | Standard Deviation 0.23 |
| Tai Chi Intervention 2 | Zeno Walkway Analysis of Gait Speed | Gait Speed Post Test | 1.17 meters/second | Standard Deviation 0.21 |